|
1
|
Yeung KTD, Kumar S, Patel N, Doyle J, Strauss D, Bhogal RH. The role for pancreatic preserving surgery for duodenal (D2) gastrointestinal stromal tumours. Surg Endosc 2025; 39:3167-3172. [PMID: 40204905 DOI: 10.1007/s00464-025-11692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 03/30/2025] [Indexed: 04/11/2025]
Abstract
INTRODUCTION A variety of surgical options are available to achieve a complete oncological resection for duodenal gastrointestinal stromal tumours (GISTs). The most common location of such tumours is the second portion (D2) of the duodenum. The key step in assessing the feasibility of localised duodenal resection is the relationship between the GIST and ampulla. We present our surgical approach and results for patients with D2 GISTs undergoing surgical resection at our tertiary oncology centre. METHODS Patients diagnosed with duodenal GIST involving D2 who underwent surgical resection at The Royal Marsden NHS Foundation Trust between March 2018 and May 2024 were included in this study. RESULTS 11 patients with D2 GISTs were included in the study. The mean age was 60 ± 11.2 years. The majority (n = 9) of patients presented with gastrointestinal haemorrhage. The locations of duodenal GIST were D1/2 (n = 1), D2 (n = 8), and D2/3 (n = 2). 9 patients received neoadjuvant Imatinib treatment. 10 patients had peri-ampullary D2 GISTs resected with pancreatic preservation. There were no anastomotic or duodenotomy leaks. One patient developed delayed gastric emptying (DGE). One patient who underwent segmental D2/3 resection and duodeno-jejunostomy developed biliary obstruction and required PTC and biliary stent. One patient who presented with biliary obstruction underwent pancreaticoduodenectomy developed a Grade A post-operative pancreatic fistula. The median study follow-up was 38 months (range 3-72 months) and at the end of the study period only one patient had developed recurrence. All patients remain disease free and under active follow-up. CONCLUSION In summary, we demonstrate that for D2 GISTs presenting without biliary obstruction, localised D2 resection should be considered, and this approach is associated with low patient morbidity and good long-term patient outcomes.
Collapse
Affiliation(s)
| | - Sacheen Kumar
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
- The Institute of Cancer Research, Old Brompton Road, London, SW3 3RP, UK
| | - Nikhil Patel
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Joseph Doyle
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Dirk Strauss
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Ricky H Bhogal
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK.
- The Institute of Cancer Research, Old Brompton Road, London, SW3 3RP, UK.
| |
Collapse
|
|
2
|
Wu L, Liu M, Lin X, Wang C, Yang Y, Fang H, Huang H, Lin R, Lu F. Feasibility and efficacy of minimally invasive limited resection for primary duodenal gastrointestinal stromal tumors: a retrospective cohort study. BMC Surg 2024; 24:126. [PMID: 38678296 PMCID: PMC11055357 DOI: 10.1186/s12893-024-02417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST. METHODS The clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD). RESULTS A total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group. All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups. CONCLUSIONS Minimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.
Collapse
Affiliation(s)
- Longhang Wu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Miao Liu
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, Fujian, China
- Department of Gastrointestinal Endoscopy Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| |
Collapse
|
|
3
|
Wang ZZ, Yan XD, Yang HD, Mao XL, Cai Y, Fu XY, Li SW. Effectiveness and safety of endoscopic resection for duodenal gastrointestinal stromal tumors: A single center analysis. World J Gastrointest Endosc 2022; 14:684-693. [PMID: 36438879 PMCID: PMC9693683 DOI: 10.4253/wjge.v14.i11.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/28/2022] [Accepted: 10/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Endoscopic resection for duodenal gastrointestinal stromal tumors (GISTs) is still considered a great challenge with a high risk of complications, including perforation, bleeding, tumor rupture, and residual tumor. AIM To assess the effectiveness and safety of endoscopic resection for duodenal GISTs. METHODS Between January 2010 and January 2022, 11 patients with duodenal GISTs were treated with endoscopic resection. Data were extracted for the incidence of complete resection, bleeding, perforation, postoperative infection, recurrence, and distant metastasis. RESULTS The incidence of successful complete resection of duodenal GISTs was 100%. Three cases (27.3%) had suspected positive margins, and the other 8 cases (72.7%) had negative vertical and horizontal margins. Perforation occurred in all 11 patients. The success rate of perforation closure was 100%, while 1 patient (9.1%) had suspected delayed perforation. All bleeding during the procedure was managed by endoscopic methods. One case (9.1%) had delayed bleeding. Postoperative infection occurred in 6 patients (54.5%), including 1 who developed septic shock and 1 who developed a right iliac fossa abscess. All 11 patients recovered and were discharged. The mean hospital stay was 15.3 d. During the follow-up period (14-80 mo), duodenal stenosis occurred in 1 case (9.1%), and no local recurrence or distant metastasis were detected. CONCLUSION Endoscopic resection for duodenal GISTs appears to be an effective and safe minimally invasive treatment when performed by an experienced endoscopist.
Collapse
Affiliation(s)
- Zhen-Zhen Wang
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Xiao-Dan Yan
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Hai-Deng Yang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Yue Cai
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Xin-Yu Fu
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| | - Shao-Wei Li
- Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
- Institute of Digestive Disease, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 315000, Zhejiang Province, China
| |
Collapse
|
|
4
|
Sharma A, Nagar A, Varshney P, Tomar M, Sarin S, Choubey RP, Kapoor VK. Pancreas-preserving limited duodenal resection: Minimizing morbidity without compromising oncological adequacy. Ann Hepatobiliary Pancreat Surg 2022; 26:149-158. [PMID: 35168204 PMCID: PMC9136427 DOI: 10.14701/ahbps.21-124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Pancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of mortality. Pancreas-preserving limited duodenal resection (PPLDR) can be performed under specific scenarios. We share our experience with PPLDR and its outcome. Methods We retrospectively analyzed a prospectively maintained database of patients undergoing limited duodenal resection in the form of wedge (sleeve) resection or segmental resection of one or more duodenal segments from March 2016 to March 2021 at a tertiary care center in North India. Results During the study period, 10 patients (including 9 males) underwent PPLDR. Five of these 10 patients showed primary duodenal or proximal jejunal pathology, while the remaining five had duodenal pathology involving an adjacent organ tumor. Four patients underwent wedge (sleeve) resection, while the remaining six underwent segmental duodenal resection of one or more duodenal segments. Mean hospital stay was 6 days (range, 3-11 days) without 30-day mortality. Morbidity occurred in 4 patients (Grade I-II, n = 3; Grade III, n = 1). All patients were alive and disease-free at the time of last follow-up. The mean follow-up duration was 23 months (range, 2-48 months). Conclusions PPLDR is a safe and effective alternative for pancreaticoduodenectomy when selected carefully for specific tumor types and location.
Collapse
Affiliation(s)
- Ajay Sharma
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| | - Anand Nagar
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| | - Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Maunil Tomar
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| | - Shashwat Sarin
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| | - Rajendra Prasad Choubey
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| | - V. K. Kapoor
- Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
| |
Collapse
|
|
5
|
Fabbi M, Castoldi L, Sallusti M, Rossi G, Reggiani P. Duodenal Gastrointestinal Stromal Tumor: A Rare Disease in a Young Adult Female Patient Presenting with Life-Threatening Hemorrhage. Case Rep Gastroenterol 2021; 15:519-524. [PMID: 34616250 PMCID: PMC8454229 DOI: 10.1159/000515370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/17/2021] [Indexed: 12/03/2022] Open
Abstract
Duodenal gastrointestinal stromal tumors (dGISTs) may be a source of life-threatening hemorrhage that leads to emergency surgical care, precluding tumor staging and the planning of an elective treatment. In this study, we report a case of potentially lethal bleeding dGIST in a young woman successfully treated by an organ-preserving elective surgery after endoscopic and angiographic hemostasis. A 26-year-old female patient was admitted to the Emergency Unit of our hospital with the complaints of hematemesis and melena in the previous 12 h. An upper endoscopy showed a 4-cm submucosal lesion, between the 2nd and 3rd part of the duodenum, in the lateral wall, with massive bleeding arising from central ulceration. Hemostasis was initially achieved endoscopically and then optimized by transarterial embolization. After a contrast-enhanced CT, the patient underwent planning elective surgery. Intraoperatively, a 3-cm lesion was confirmed and resected by excision of the full-thickness duodenum with adequate free margins. Immunohistochemical analysis of the specimen revealed to be a dGIST, with a low mitotic count (<5 mitosis/50 high power field), and tumor necrosis present in <50% of the lesion. The patient had an uneventful course.
Collapse
Affiliation(s)
- Manrica Fabbi
- Fondazione IRCCS Cà Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Laura Castoldi
- Fondazione IRCCS Cà Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Maurizio Sallusti
- Fondazione IRCCS Cà Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Giorgio Rossi
- Fondazione IRCCS Cà Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Paolo Reggiani
- Fondazione IRCCS Cà Granda, Maggiore Policlinico Hospital, Milan, Italy
| |
Collapse
|
|
6
|
Vassos N, Perrakis A, Hohenberger W, Croner RS. Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST). J Clin Med 2021; 10:4459. [PMID: 34640476 PMCID: PMC8509470 DOI: 10.3390/jcm10194459] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. METHODS We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12-140). RESULTS A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42-77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5-13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. CONCLUSION The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.
Collapse
Affiliation(s)
- Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| |
Collapse
|
|
7
|
El-Haddad HM, Kassem MI, Shehata GA, El-Sayes IA. Outcome after Surgical Treatment of Gastrointestinal Stromal Tumors in the Second Part of Duodenum: Is Localized Resection Appropriate? J INVEST SURG 2021; 35:814-820. [PMID: 34455896 DOI: 10.1080/08941939.2021.1968081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The second part of the duodenum is the most common part to be involved with duodenal gastrointestinal tumors (D2-GISTs). Localized resection (LR) and pancreaticoduodenectomy (PD) are two viable options for curative resection. The aim of this study is to compare the middle-term outcomes in patients with D2-GIST after either LR or PD in a single institution. PATIENTS AND METHODS Overall, 53 patients with non-metastatic D2-GIST were analyzed. Either LR or PD was executed depending on the involvement of the ampulla of Vater. The tumors were stratified in accordance with the Miettinen classification for tumor behavior. The patients were followed up for 3 years for recurrence and survival. RESULTS Thirty-two of the patients were females (60%) and 21 males (40%), with a mean age of 55 ± 8 years. Bleeding was the most common presentation in 19 patients (36%). LR was performed in 41 patients (77%), whereas PD was performed in 12 patients (23%). Three-year survival and recurrence were comparable between the two groups. The disease-free survival at 3 years was 85% and 92% in LR and PD group, respectively. The PD group had a significantly longer operative time and a higher incidence of postoperative pancreatic fistula. Otherwise, no statistically significant difference was calculated. A significantly shorter survival was calculated in those with a mitotic index of >5 and also for tumors classified as high grade in accordance with the Miettinen classification. 71% of those with recurrence had high mitotic index > 5/hpf. CONCLUSIONS LR for D2-GIST is an acceptable alternative to PD with satisfactory middle-term outcomes. For tumors involving the ampulla of Vater, PD is still indicated. Furthermore, tumor biology predicts the likelihood of survival and recurrence.
Collapse
Affiliation(s)
- Hany M El-Haddad
- General Surgery Department, Faculty of Medicine, Alexandria University, Egypt
| | - Mohammed I Kassem
- General Surgery Department, Faculty of Medicine, Alexandria University, Egypt
| | - Gihan A Shehata
- Medical Statistics Department, Medical Research Institute, Alexandria University, Egypt
| | - Islam A El-Sayes
- General Surgery Department, Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
|
8
|
Arkhiri PP, Stilidi IS, Nered SN, Abgaryan MG, Nikulin MP, Meshcheryakov AA, Filonenko DA, Egenov OA, Yugai VV, Volkov AY. [Surgical and combined treatment of patients with duodenal stromal tumors]. Khirurgiia (Mosk) 2021:11-19. [PMID: 34363440 DOI: 10.17116/hirurgia202108111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the immediate and long-term results of surgical and combined treatment of patients with duodenal stromal tumors. MATERIAL AND METHODS There were 47 patients with duodenal stromal tumors for the period 2002-2019. All patients underwent treatment at the Blokhin National Cancer Research Center. Six patients had metastatic disease, 2 ones - a rare syndrome of duodenal stromal tumor associated with neurofibromatosis type 1, other 39 patients had a localized and locally-advanced disease. Surgical treatment was performed in 37 patients (limited resections (LR) in 24 cases and gastropancreaticoduodenectomy in 13 cases). Incidence of postoperative complications was significantly lower after limited resections compared to gastropancreaticoduodenectomy (22.2% (6/24) vs. 61.5% (8/13), respectively). Severe complications (Clavien-Dindo grade 3) occurred in 4.2% (1/24) vs. 15.3% (2/13) of patients, respectively. Postoperative mortality was absent in both groups. We observed no significant differences in long-term results. Overall 5-year survival was 91% and 70% (p=0.5960), 5-year recurrence-free survival - 65 and 70% (p=0.6226), respectively. CONCLUSION Considering similar survival rates, lower postoperative morbidity and better quality of life, limited duodenal resections are preferred for duodenal stromal tumors.
Collapse
Affiliation(s)
- P P Arkhiri
- Blokhin National Cancer Research Center, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I S Stilidi
- Blokhin National Cancer Research Center, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S N Nered
- Blokhin National Cancer Research Center, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M G Abgaryan
- Blokhin National Cancer Research Center, Moscow, Russia
| | - M P Nikulin
- Blokhin National Cancer Research Center, Moscow, Russia
| | | | - D A Filonenko
- Blokhin National Cancer Research Center, Moscow, Russia
| | - O A Egenov
- Blokhin National Cancer Research Center, Moscow, Russia
| | - V V Yugai
- Blokhin National Cancer Research Center, Moscow, Russia
| | - A Yu Volkov
- Blokhin National Cancer Research Center, Moscow, Russia
| |
Collapse
|
|
9
|
|
|
10
|
Jung H, Lee SM, Kim YC, Byun J, Kwon MJ. A pictorial review on clinicopathologic and radiologic features of duodenal gastrointestinal stromal tumors. Diagn Interv Radiol 2020; 26:277-283. [PMID: 32558653 PMCID: PMC7360074 DOI: 10.5152/dir.2019.19432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/30/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
Duodenal gastrointestinal stromal tumors (GISTs) are rare, and studies on their management are not sufficient. Owing to the complex anatomy of the duodenum and pancreatic head, GISTs can be misdiagnosed as pancreatic head tumors. Surgical resection is the first treatment for localized duodenal GISTs; thus, noninvasive imaging is important for the diagnosis and treatment of GISTs. Computed tomography, magnetic resonance imaging and endoscopic ultrasonography findings can be helpful for the diagnosis of duodenal GISTs and can help differentiate GISTs from other adjacent tumors.
Collapse
Affiliation(s)
- Haerang Jung
- From the Department of Radiology (H.J. , S.M.L.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (Y.C.K.), Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (J.B.) Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; and the Department of Pathology (M.J.K.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Min Lee
- From the Department of Radiology (H.J. , S.M.L.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (Y.C.K.), Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (J.B.) Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; and the Department of Pathology (M.J.K.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Young Chul Kim
- From the Department of Radiology (H.J. , S.M.L.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (Y.C.K.), Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (J.B.) Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; and the Department of Pathology (M.J.K.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Jieun Byun
- From the Department of Radiology (H.J. , S.M.L.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (Y.C.K.), Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (J.B.) Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; and the Department of Pathology (M.J.K.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| | - Mi Jung Kwon
- From the Department of Radiology (H.J. , S.M.L.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (Y.C.K.), Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Republic of Korea; Department of Radiology (J.B.) Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea; and the Department of Pathology (M.J.K.) Hallym University Sacred Heart Hospital, Gyeonggi-do, Republic of Korea
| |
Collapse
|
|
11
|
Duodenal GIST: Surgical treatment based on the location. A single center experience with review of the literature. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.760582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
|
12
|
Lu C, Jin W, Mou Y, Shao H, Wu X, Li S, Xu B, Wang Y, Zhu Q, Xia T, Zhou Y. Optimal Laparoscopic Management and Oncological Outcomes of Gastrointestinal Stromal Tumors in Duodenum: Pancreaticoduodenectomy or Pancreas-Sparing Duodenectomy? Cancer Manag Res 2020; 12:4725-4734. [PMID: 32606963 PMCID: PMC7310982 DOI: 10.2147/cmar.s254972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) of the duodenum are rarely reported and optimal minimally invasive management has not been well proposed. Pancreaticoduodenectomy and different types of pancreas-sparing duodenectomy can be chosen; however, which to choose and its corresponding clinical outcomes and oncological concerns remain controversial. Patients and Methods Patients diagnosed with GIST of duodenum underwent laparoscopic pancreaticoduodenectomy (L-PD) or pancreas-sparing duodenectomy (L-PSD) in Zhejiang Provincial People's Hospital were enrolled. All prospectively maintained data were analyzed retrospectively. Patients were grouped into the L-PD group or the L-PSD group, and the clinical outcomes and oncological outcomes were analyzed. Results Between June 2013 and March 2019, a total of 22 patients (11 males/11 females) underwent surgical management, including 13 L-PDs and 9 L-PSDs. The average age was 58.2±9.5 year-old (median 60.5 year-old). The most common presentations were GI bleeding (54.5%) and abdominal discomfort (27.2%), and the dominant lesion located in the second portion of duodenum (59.1%). Compared with L-PD group, L-PSD group showed much shorter operation time (364.2±58.7min vs. 230.0±12.3min, P<0.001), less blood loss (176.9±85.7mL vs. 61.1±18.2min, P<0.001), faster recovery to off-bed (2.6±1.3d vs. 1.1±0.3d, P=0.003), anus flatus (4.5±1.0d vs. 2.4±0.5d, P<0.001) and liquid intake (4.9±1.3d vs. 2.3±0.5d, P<0.001). Lymph node retrieval was much less in L-PSD, but no lymph node metastasis was observed in any patients. L-PSD had much Lower morbidity of both minor (Grade I/II) and major (III/IV/V) complications than that of L-PD (11.1% vs. 61.6%, P=0.02), resulting in shorter hospital stays (10.9±3.8d vs. 20.6±11.1d, P=0.021) and less total cost (76,972.4±11,614.8yuan vs 125,628.7±46,356.8yuan, P=0.006). The median follow-up was 42 months (range from 12 to 82months) without loss. Only 1 L-PD patient suffered hepatic metastasis 36months after surgery, and given sunitinib to stabilize the disease, none of the rest observed recurrence or metastasis. Conclusion For GIST located opposite the major papilla, L-PSD showed comparable safety and oncological benefits when compared to L-PD, with shorter operation time, less blood loss and much faster recovery time, resulting in much less total cost. L-PSD should be applied in selected patients with experienced hands.
Collapse
Affiliation(s)
- Chao Lu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.,School of Medicine, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Weiwei Jin
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hongliang Shao
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Xiaosan Wu
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Shaodong Li
- School of Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Biwu Xu
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Yuanyu Wang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qicong Zhu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Tao Xia
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yucheng Zhou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.,School of Medicine, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| |
Collapse
|
|
13
|
Zhou Y, Wang X, Si X, Wang S, Cai Z. Surgery for duodenal gastrointestinal stromal tumor: A systematic review and meta-analysis of pancreaticoduodenectomy versus local resection. Asian J Surg 2020; 43:1-8. [PMID: 30853211 DOI: 10.1016/j.asjsur.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/02/2019] [Accepted: 02/19/2019] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study is to assess the clinical outcomes and prognostic factors for survival of patients with duodenal gastrointestinal stromal tumors (GIST) who underwent pancreaticoduodenectomy (PD) or local resection (LR). PubMed database was searched for relevant studies. A meta-analysis was performed with Review Manager 5.3 software. Twenty-seven observational studies involving 1103 patients were included in the review. The overall morbidity and 30-day mortality was 27% and 0.5% respectively. The median (range) 5-year overall survival (OS) and disease-free survival (DFS) rates were 87% (60-100%) and 71% (44-100%) respectively. In meta-analyses, factors associated with shorter DFS included male sex, mitotic index >5/50 high-power fields, high risk, tumor size >5 cm, and the PD procedure. Factors associated with shorter OS included mitotic index >5/50 high-power fields and tumor size >5 cm. Patients in PD group had a higher incidence of mitotic index >5/50 HPF, a higher incidence of high-risk classification, a higher incidence of tumors in the second portion of the duodenum, a larger tumor size, a longer duration of operation, more intraoperative blood loss, a greater blood transfusion requirement, a higher morbidity rate, a longer hospital stay, and an increased recurrence rate than those in LR group. In conclusion, the current literature review demonstrates that the postoperative prognosis of duodenal GIST is promising and mainly affected by tumor factors. The choice of the surgical approach should depend on the anatomical location and tumor size.
Collapse
Affiliation(s)
- Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Xuefeng Wang
- Department of Hepatobiliary Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaoying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shijie Wang
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhibin Cai
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| |
Collapse
|
|
14
|
Guerra F, Paolini C, Vegni A, Gasperoni S, Desiderio J, Parisi A, Coratti A. Feasibility of robotic resection of gastrointestinal stromal tumors along the entire gastrointestinal tract. Updates Surg 2019; 71:695-700. [PMID: 30019164 DOI: 10.1007/s13304-018-0568-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
Abstract
Robotic surgery has been proposed over the last decade as a valid option to treat gastrointestinal malignancies in a minimally invasive method, yielding encouraging results. The authors examine the outcomes of a consecutive series of patients with stromal gastrointestinal neoplasms who were operated on using a totally robotic technique. There were 36 patients in the study, with median age 70 years. Resected tumors were located in the esophagus, stomach, duodenum, small intestine and rectum. Perioperative morbidity was 8% and no mortality occurred. R0 resection was achieved in all cases. At a median follow-up of 25 months, 35 patients were disease free while there was one case of death related to metastatic disease. Robotic surgery is a valid option to resect gastrointestinal stromal tumors anywhere along the gastrointestinal tract in a minimally invasive manner.
Collapse
Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy.
| | - Claudia Paolini
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Alessandra Vegni
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Silvia Gasperoni
- Division of Clinical Oncology, Careggi University Hospital, Florence, Italy
| | - Jacopo Desiderio
- Division of Digestive and Liver Surgery, Santa Maria Hospital, Terni, Italy
| | - Amilcare Parisi
- Division of Digestive and Liver Surgery, Santa Maria Hospital, Terni, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| |
Collapse
|
|
15
|
Huang Y, Chen G, Lin L, Jin X, Kang M, Zhang Y, Shi D, Chen K, Guo Q, Chen L, Wu D, Huang P, Chen J. Resection of GIST in the duodenum and proximal jejunum: A retrospective analysis of outcomes. Eur J Surg Oncol 2019; 45:1950-1956. [DOI: 10.1016/j.ejso.2019.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 01/10/2023] Open
|
|
16
|
Krishnamurthy G, Singh H, Sharma V, Savlania A, Vasishta RK. Therapeutic Challenges in the Management of Bleeding Duodenal Gastrointestinal Stromal Tumor: a Case Report and Review of Literature. J Gastrointest Cancer 2019; 50:170-174. [PMID: 30628032 DOI: 10.1007/s12029-018-00197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Duodenum is an uncommon site for the gastrointestinal stromal tumors (GISTs). Though the principles of management are the same of that elsewhere in the gastrointestinal tract, the anatomical complexity poses challenges in deciding the most appropriate treatment. A bleeding GIST further compounds the difficulty in managing such patients. CASE REPORT A twenty-eight-year-old female presented with bleeding duodenal lesion secondary to mucosal ulceration. Imaging confirmed large heterogeneous lesion arising from the second part of duodenum. Surgery was planned in view of persistent blood transfusion requirement. Pancreaticoduodenectomy was done and the patient had an uneventful postoperative period. DISCUSSION Review of literature of duodenal GIST especially regarding the tough decisions that have to be made in the diagnosis and management of bleeding lesions has been done. CONCLUSION The availability of various options in addressing bleeding duodenal GIST should make the surgeon choose the best modality for the patient weighing the pros and cons of each modality.
Collapse
Affiliation(s)
- Gautham Krishnamurthy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Vishal Sharma
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ajay Savlania
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Rakesh Kumar Vasishta
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| |
Collapse
|
|
17
|
Lee SJ, Song KB, Lee YJ, Kim SC, Hwang DW, Lee JH, Shin SH, Kwon JW, Hwang SH, Ma CH, Park GS, Park YJ, Park KM. Clinicopathologic Characteristics and Optimal Surgical Treatment of Duodenal Gastrointestinal Stromal Tumor. J Gastrointest Surg 2019; 23:270-279. [PMID: 30132296 DOI: 10.1007/s11605-018-3928-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinicopathologic characteristics of duodenal gastrointestinal stromal tumor (GIST) were unclear and the optimal surgical procedure for duodenal GIST remains poorly defined. We aimed to analyze clinicopathological characteristics, survival outcomes based on the surgical procedure, and recommend optimal surgical treatment for duodenal GIST. METHODS From July 2000 to April 2017, 118 patients with localized duodenal GIST underwent curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes. RESULTS The 5-year overall survival (OS) and disease-free survival (DFS) rates were 94.9 and 79.2%, respectively. On multivariate analysis, the mitotic count was a statistically significant prognostic factor for DFS. Limited resection (LR) was performed in 20 patients with GIST in the first or fourth portion of the duodenum. Both LR and pancreaticoduodenectomy (PD) were performed in 98 patients with GIST in second or third portion of the duodenum. The patients in the LR group had less late complications than in the PD group and no postoperative newly developed diabetes mellitus. The minimally invasive LR (MI-LR) group had a shorter duration of surgery and shorter length of postoperative hospital stay. CONCLUSION LR is a feasible and effective surgical treatment for patients with small-sized and antimesenteric-sided duodenal GIST in terms of late complications and postoperative diabetic complications. MI-LR has better perioperative outcomes than open LR. Therefore, we should consider MI-LR as an optimal surgical treatment for selected patients with duodenal GIST.
Collapse
Affiliation(s)
- Seung Jae Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea.
| | - Young-Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Jae Woo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Seung Hyun Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Chung Hyeun Ma
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Gui Suk Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Ye Jong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Kwang-Min Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| |
Collapse
|
|
18
|
Stilidi IS, Nered SN, Nikulin MP, Egenov OA, Petrosyan AP, Arkhiri PP. Distal duodenectomy: a new option of surgical treatment for duodenal tumors. Khirurgiia (Mosk) 2019:5-12. [PMID: 31532160 DOI: 10.17116/hirurgia20190915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess severity, safety and functional advisability of distal pancreatectomy using original surgical technique developed in the Blokhin National Medical Research Centre of Oncology. MATERIAL AND METHODS There were 10 patients with duodenal malignancies who have undergone distal pancreatectomy in the Blokhin National Medical Research Centre of Oncology for the period 2006-2018. Distal pancreatectomy for primary duodenal tumors was performed in 8 patients, 2 patients underwent surgery for external invasion of the duodenum. RESULTS Postoperative complications Clavien-Dindo grade 1 and 2 occurred in 4 (40%) patients. Surgical complication grade 2 occurred in 1 (10%) patient (pancreatic fistula with effective conservative management). There were no cases of leakage of duodenal stump and duodenojejunostomy, impaired bile flow and stenosis of anastomosis with delayed stomach emptying. CONCLUSION Distal duodenectomyis associated with low postoperative morbidity, good functionality and quality of life. This procedure is preferred for non-epithelial and neuroendocrine tumors, as well as with secondary malignant duodenal invasion.
Collapse
Affiliation(s)
- I S Stilidi
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Health Ministry of the Russia, Moscow, Russia
| | - S N Nered
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Health Ministry of the Russia, Moscow, Russia
| | - M P Nikulin
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
| | - O A Egenov
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
| | - A P Petrosyan
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
| | - P P Arkhiri
- Blokhin National Medical Research Centre of oncology of the Health Ministry of the Russia, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Health Ministry of the Russia, Moscow, Russia
| |
Collapse
|
|
19
|
Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
Collapse
Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
| |
Collapse
|
|
20
|
Liu Z, Zheng G, Liu J, Liu S, Xu G, Wang Q, Guo M, Lian X, Zhang H, Feng F. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: a series of 300 patients. BMC Cancer 2018; 18:563. [PMID: 29764388 PMCID: PMC5952823 DOI: 10.1186/s12885-018-4485-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/08/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor still under debate. Thus, this study aimed to explore the optimal surgical strategy and prognosis of duodenal GISTs. METHODS A total of 300 cases of duodenal GISTs were obtained from our center (37 cases) and from case reports or series (263 cases) extracted from MEDLINE. Clinicopathological features, type of resections and survivals of duodenal GISTs were analyzed. RESULTS The most common location of duodenal GISTs was descending portion (137/266, 51.5%). The median tumor size was 4 cm (0.1-28). Most patients (66.3%) received limited resection (LR). Pancreaticoduodenectomy (PD) was mainly performed for GISTs with larger tumor size or arose from descending portion (both P < 0.05). For both the entire cohort and tumors located in the descending portion, PD was not an independent risk factor for disease-free survival (DFS) and disease-specific survival (DSS) (both P > 0.05). Duodenal GISTs were significantly different from gastric GISTs with respect to tumor size, mitotic index and NIH risk category (all P < 0.05). The DFS and DSS of duodenal GISTs was significantly worse than that of gastric GISTs (both P < 0.05). CONCLUSIONS LR was a more prevalent surgical procedure and PD was mainly performed for tumors with larger diameter or located in descending portion. Type of resection was not an independent risk factor for the prognosis of duodenal GISTs. Prognosis of duodenal GISTs was significantly worse than that of gastric GISTs.
Collapse
Affiliation(s)
- Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No.1 Hospital of PLA, 74 Jingning Road, Lanzhou, 730030 China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Jinqiang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Cadre’ s sanitarium, 62101 Army of PLA, 67 Nahu Road, Xinyang, 464000 Henan China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, 454000 Henan China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| |
Collapse
|
|
21
|
Golhar A, Mangla V, Mehrotra S, Lalwani S, Mehta N, Nundy S. Limited distal duodenal resection: Surgical approach and outcomes. A case series. Ann Med Surg (Lond) 2018; 30:36-41. [PMID: 30013770 PMCID: PMC6019849 DOI: 10.1016/j.amsu.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Tumours involving the duodenum are usually treated with pancreaticoduodenectomy, which may be associated with considerable morbidity. Limited distal duodenal resection, a relatively smaller procedure, can be done in some of these patients. We describe our experience with this operation for such lesions. Methods We retrospectively analyzed, from prospectively collected data 10 consecutive patients who underwent limited duodenal and proximal jejunal resection between March 2011 and Nov 2015. Results There were 8 males and 2 females who had a median age of 47 years. Their common presentations were abdominal pain (50%) and upper gastrointestinal bleeding (40%). Five had malignancy (adenocarcinoma: 2, neuroendocrine tumours: 2, non Hodgkin's lymphoma 1). Three had gastrointestinal stromal tumours (GISTs) and 2 had other benign tumours (lipoma 1, ectopic pancreas 1). The 30-day post-operative morbidity rate was 60% (n = 6) with mostly minor complications (Clavien grade 1 or 2). Median post-operative stay was 9 (range, 6–13) days. All ten patients were alive without recurrence after a median follow up of 26.5 months. Conclusion Limited distal duodenal resection is a feasible surgical alternative to a pancreaticoduodenectomy in carefully selected patients with benign and some malignant tumours of the third and fourth part of the duodenum.
Pancreaticodudenctomy is the usual treatment for tumours of the duodenum, which still has 30–50% morbidity. Limited resection of the duodenum without pancreatic head resection for benign as well carefully selected malignant tumours of the distal duodenum has considerably lesser morbidity. Cattell and Braash maneuver and mobilization of the ligament of Treitz is very helpful during such resection. The present study suggests the feasibility of performing such limited resection with equivalent survival and oncological outcomes.
Collapse
Affiliation(s)
- Ankush Golhar
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Siddharth Mehrotra
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Shailendra Lalwani
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation (Unit 1), Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India
| |
Collapse
|
|
22
|
Hayashi K, Kamimura K, Hosaka K, Ikarashi S, Kohisa J, Takahashi K, Tominaga K, Mizuno K, Hashimoto S, Yokoyama J, Yamagiwa S, Takizawa K, Wakai T, Umezu H, Terai S. Endoscopic ultrasound-guided fine-needle aspiration for diagnosing a rare extraluminal duodenal gastrointestinal tumor. World J Gastrointest Endosc 2017; 9:583-589. [PMID: 29290914 PMCID: PMC5740104 DOI: 10.4253/wjge.v9.i12.583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/04/2017] [Accepted: 10/16/2017] [Indexed: 02/06/2023] Open
Abstract
Duodenal gastrointestinal stromal tumors (GISTs) are extremely rare disease entities, and the extraluminal type is difficult to diagnose. These tumors have been misdiagnosed as pancreatic tumors; hence, pancreaticoduodenectomy has been performed, although partial duodenectomy can be performed if accurately diagnosed. Developing a diagnostic methodology including endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) has allowed us to diagnose the tumor directly through the duodenum. Here, we present a case of a 50-year-old woman with a 27-mm diameter tumor in the pancreatic uncus on computed tomography scan. EUS showed a well-defined hypoechoic mass in the pancreatic uncus that connected to the duodenal proper muscular layer and was followed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Histological examination showed spindle-shaped tumor cells positively stained for c-kit. Based on these findings, the tumor was finally diagnosed as a duodenal GIST of the extraluminal type, and the patient underwent successful mass resection with partial resection of the duodenum. This case suggests that EUS and EUS-FNA are effective for diagnosing the extraluminal type of duodenal GISTs, which is difficult to differentiate from pancreatic head tumor, and for performing the correct surgical procedure.
Collapse
Affiliation(s)
- Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazunori Hosaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazuya Takahashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kenichi Mizuno
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Satoshi Yamagiwa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazuyasu Takizawa
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hajime Umezu
- Department of Pathology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| |
Collapse
|
|
23
|
Umemoto K, Nakanishi Y, Murakawa K, Suzuki T, Yamamura Y, Ono K, Hirano S. Laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor located in the second portion of the duodenum: A case report. Asian J Endosc Surg 2017; 10:411-414. [PMID: 28598031 DOI: 10.1111/ases.12391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/18/2017] [Accepted: 04/23/2017] [Indexed: 12/01/2022]
Abstract
Gastrointestinal stromal tumors of the duodenum are rare. For benign tumors, premalignant lesions, or malignant potential tumors located in the second portion of the duodenum close to the papilla of Vater, pancreaticoduodenectomy is sometimes performed. A case of laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor at the second portion of the duodenum is reported. The surgical procedure was performed as follows: first, the second portion of the duodenum was separated from the pancreatic head; second, the duodenum was cut off with the linear stapler after having confirmed preservation of the papilla by intraoperative endoscopy; and third, reconstruction was carried out by a side-to-side duodenojejunostomy. Laparoscopic segmental duodenectomy for duodenal gastrointestinal stromal tumors is thought to be advantageous compared with pancreaticoduodenectomy in terms of low burden and organ function preservation. The present procedure is feasible for benign or low-malignant tumors that do not infiltrate outside of the duodenal walls.
Collapse
Affiliation(s)
- Kazufumi Umemoto
- Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshitsugu Nakanishi
- Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Tomohiro Suzuki
- Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshiyuki Yamamura
- Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan.,Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koichi Ono
- Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
|
24
|
Chen P, Song T, Wang X, Zhou H, Zhang T, Wu Q, Kong D, Cui Y, Li H, Li Q. Surgery for Duodenal Gastrointestinal Stromal Tumors: A Single-Center Experience. Dig Dis Sci 2017; 62:3167-3176. [PMID: 28914399 DOI: 10.1007/s10620-017-4742-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 08/29/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The duodenal gastrointestinal stromal tumors (GISTs) are an extremely rare subset of GISTs. The optimal surgical procedure remains not well defined. AIMS We assessed the surgical approach and long-term outcomes of patients with duodenal GISTs who underwent limited resection (LR) versus pancreaticoduodenectomy (PD). METHODS From November 2005 to January 2016, 64 consecutive patients with duodenal GISTs in a single center were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and perioperative outcomes were analyzed according to the different surgical type. RESULTS A total of 41 patients (64.1%) underwent LR, while 23 patients (35.9%) underwent PD. All patients had negative surgical margins (R0). Median tumor size was larger for PD (6 cm) versus LR (4 cm) (P = 0.041). PD also had more complications than LR (PD, 69.6 vs. LR, 31.7%) (P = 0.002). The 3-year and 5-year RFS was 62.9 and 44.3%, respectively. The 3-year and 5-year OS was 85.7 and 59.5%, respectively. The multivariate analysis demonstrated the only unfavorable predictive factor was tumor size >5 cm for RFS and OS. Although the complication rate in the PD group was higher than in the LR group, OS and RFS were not affected by the complication (P = 0.492 for OS, P = 0.512 for RFS). PD versus LR was not associated with RFS and OS. Adjuvant imatinib mesylate (IM) did not improve the survival of the patients after operation. CONCLUSIONS Survival of duodenal GISTs is mainly dependent on tumor biology rather than surgical procedure. LR should be the surgical procedure of choice for duodenal GISTs when technically feasible and no anatomical constrains. LR shows comparable survival and lower risk of postoperative complications compared by PD. The administration of IM both as adjuvant and neoadjuvant therapy for duodenal GISTs needs large population and prospective study to evaluate its effect.
Collapse
Affiliation(s)
- Ping Chen
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Tianqiang Song
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China.
| | - Xin Wang
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Hongyuan Zhou
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Ti Zhang
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Qiang Wu
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Dalu Kong
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Yunlong Cui
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Huikai Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| | - Qiang Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Nation Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, 3 Huanhu West Road, Hexi District, Tianjin, 300060, China
| |
Collapse
|
|
25
|
Zioni T, Dizengof V, Kirshtein B. Laparoscopic resection of duodenal gastrointestinal stromal tumour. J Minim Access Surg 2017; 13:157-160. [PMID: 28281485 PMCID: PMC5363127 DOI: 10.4103/0972-9941.195576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/15/2016] [Indexed: 12/22/2022] Open
Abstract
Only a few studies have revealed using laparoscopic technique with limited resection of gastrointestinal stromal tumour (GIST) of the duodenum. A 68-year-old man was admitted to the hospital due to upper gastrointestinal (GI) bleeding. Evaluation revealed an ulcerated, bleeding GI tumour in the second part of the duodenum. After control of bleeding during gastroduodenoscopy, he underwent a laparoscopic wedge resection of the area. During 1.5 years of follow-up, the patient is disease free, eats drinks well, and has regained weight. Surgical resection of duodenal GIST with free margins is the main treatment of this tumour. Various surgical treatment options have been reported. Laparoscopic resection of duodenal GIST is an advanced and challenging procedure requiring experience and good surgical technique. The laparoscopic limited resection of duodenal GIST is feasible and safe, reducing postoperative morbidity without compromising oncologic results.
Collapse
Affiliation(s)
- Tammy Zioni
- Department of Surgery “A”, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Vitaliy Dizengof
- Department of Gastroenterology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Boris Kirshtein
- Department of Surgery “A”, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| |
Collapse
|
|
26
|
Ye LP, Mao XL, Zheng HH, Zhang Y, Shen LY, Zhou XB, Zhu LH. Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 2017; 31:1070-1077. [PMID: 27387179 DOI: 10.1007/s00464-016-5065-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic removal of a duodenal lesion is still considered to be a challenging procedure that can be fraught with potentially serious complications, specifically perforation or delayed bleeding. This study was to assess the safety of endoscopic resection for duodenal subepithelial lesions (SELs) with wound closure using clips and an endoloop. METHODS From October 2010 to July 2015, a total of 68 consecutive patients with duodenal SELs were treated with endoscopic resection with wound closure using clips and an endoloop. The main outcome measures considered were the incidence of complete resection, perioperative perforation, delayed perforation, delayed bleeding, residual lesions, and lesion recurrence. RESULTS Complete resection was successfully achieved for all 68 patients. The median lesion size was 1.7 cm. The median procedure time was 62 min. The mean hospital stay was 5.5 days. During the procedure, five patients developed perioperative perforations (7.4 %) and no patients developed delayed bleeding, delayed perforation, or other serious complications. The five patients with perioperative perforations recovered after conservative treatment. The perioperative perforation rate was significantly higher for lesions originating in the muscularis propria layer (18.2 %) than in the submucosal layer (2.2 %; p < 0.05). No residual or recurrent lesions were detected during the follow-up period (median: 27 months). CONCLUSIONS Endoscopic resection with wound closure using clips and an endoloop is an effective and reasonably safe therapeutic method for treating/removing duodenal SELs when managed by an experienced endoscopic team, and it can provide an alternative treatment option for patients with duodenal SELs.
Collapse
Affiliation(s)
- Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang Province, China
| | - Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
| | - Ling-Yan Shen
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| |
Collapse
|
|
27
|
Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature. Aging Clin Exp Res 2017; 29:1-6. [PMID: 27844452 DOI: 10.1007/s40520-016-0641-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3-5% of all GISTs and represent 10-30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding. CASES We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma. DISCUSSION Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD. CONCLUSION The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.
Collapse
|
|
28
|
Crown A, Biehl TR, Rocha FG. Local resection for duodenal gastrointestinal stromal tumors. Am J Surg 2016; 211:867-70. [PMID: 27033254 DOI: 10.1016/j.amjsurg.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/06/2016] [Accepted: 02/13/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Duodenal gastrointestinal tumors (GIST) present infrequently, and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of lymphatic and submucosal spread and anatomic location near the bile duct and pancreas, the optimal approach for resection is unknown. Options include local resection (LR), segmental resection, and pancreaticoduodenectomy (PD). METHODS All cases of gastrointestinal stromal tumors originating from the duodenum from 2000 to 2015 were identified from administrative databases. Clinical and pathologic information was abstracted from the medical record and compared between patients who received LR vs PD. The chi-square with Fisher's exact test was used to detect differences between groups. RESULTS Fifteen patients met the inclusion criteria, of which 7 had an LR and 8 had a PD. The second portion of the duodenum was the most common origin of GIST in the PD group, whereas the third portion was most common in the LR group. Patients who underwent LR tended to be younger, but there was no difference in tumor size, mitotic rate, margin positivity, readmission rate, or recurrence. PD was associated with more complications, higher blood loss, and longer length of stay. CONCLUSIONS Local resection is a reasonable option for resection of duodenal GIST and should be routinely considered if technically feasible.
Collapse
Affiliation(s)
- Angelena Crown
- Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, 1100 Ninth Av., Seattle, WA 98101, USA
| | - Thomas R Biehl
- Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, 1100 Ninth Av., Seattle, WA 98101, USA
| | - Flavio G Rocha
- Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, 1100 Ninth Av., Seattle, WA 98101, USA.
| |
Collapse
|
|
29
|
Limited resections for duodenal gastrointestinal stromal tumors and their oncologic outcomes. Surg Today 2016; 46:110-116. [PMID: 25860591 DOI: 10.1007/s00595-015-1163-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/12/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Limited resection is considered a treatment option for duodenal gastrointestinal stromal tumors (GISTs) whenever technically feasible, but the optimal technique for this is still not well defined. We present the various types of limited resections for duodenal GISTs and analyze their postoperative outcomes. METHODS The subjects of this retrospective clinicopathologic analysis were 21 patients who underwent limited resections for duodenal GIST between May, 2001 and June, 2014. The median follow-up period was 52 months (range 5-125 months). RESULTS The patients comprised 12 men and 9 women, with a median age of 59 years (range 45-75 years), all of whom were treated by various forms of limited resection with clear margins. There were ten wedge resections with primary closure (eight open/two laparoscopic), two wedge resections with Roux-en Y duodenojejunostomy, three segmental duodenectomies with end-to-end duodenoduodenostomy, and six segmental duodenectomies with end-to-end duodenojejunostomy. Hepatic metastasis was found 27 months after surgery in one patient, who was given imatinib mesylate for 17 months to slow disease progression. The other 20 patients were alive and recurrence free at the time of writing. CONCLUSION Excellent recurrence-free survival was achieved after limited resections, supporting the consideration of various methods of limited resection as the treatment of choice for duodenal GISTs.
Collapse
|
|
30
|
Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J. Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome. BMC Surg 2015; 15:98. [PMID: 26276408 PMCID: PMC4536755 DOI: 10.1186/s12893-015-0084-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/04/2015] [Indexed: 02/05/2023] Open
Abstract
Background Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. We here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST. Methods Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were retrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were calculated using Kaplan–Meier method. Results Out of 74 cases, 42 cases were female (56.76 %) and 32 cases (43.24 %) were male. Approximately 22.97, 47.30, 16.22, and 13.51 % of the tumors originated in the first to fourth portion of the duodenum, respectively, with a tumor size of 5.08 ± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00 %), abdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76 %), and others (n = 7, 9.76 %). A total of 18 patients (24.3 %) underwent wedge resection (WR); 39 patients (52.7 %) underwent segmental resection (SR); and 17 cases (23 %) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1–159 months); 19 patients (25.68 %) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69 %, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86 %, respectively. The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294). Conclusions DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.
Collapse
Affiliation(s)
- Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Haining Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiaju Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Luyin Han
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Zhixin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiaping Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| |
Collapse
|
|
31
|
Han IW, Jang JY, Lee KB, Kang MJ, Kwon W, Park JW, Chang YR, Lee HJ, Park KJ, Kim SW. Clinicopathologic analysis of gastrointestinal stromal tumors in duodenum and small intestine. World J Surg 2015; 39:1026-33. [PMID: 25270345 DOI: 10.1007/s00268-014-2810-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prognosis about duodenal GISTs is debatable. The purpose of this study is to compare the characteristics and the prognostic factors in patients with gastrointestinal stromal tumor (GIST) located in the duodenum with those located in the small intestine. METHODS One hundred-one patients with GIST located in the duodenum (n = 40), or small intestine (n = 61) underwent resection between 1996 and 2010. We analyzed clinicopathologic features, surgical outcomes, and prognostic factors. RESULTS Five-year survival rate in patients with GIST located in the duodenum and small intestine were 66.6 and 80.8%, respectively (p = 0.018). After survival analysis, high mitotic count and tumor rupture were identified as independent adverse prognostic factors. Advanced T stage and absence of adjuvant imatinib treatment were adverse prognostic factors with marginal statistical significance. The rate of progressive disease was significantly higher in patients with duodenal GISTs (36.8%) than in those with small intestinal GIST (29.6%) (p = 0.024). CONCLUSIONS The clinicopathologic findings of duodenal GIST differ from those of small intestinal GIST. Patients with duodenal GIST have a worse prognosis than those with small intestinal GIST. Aggressive treatment including surgical resection should be considered for duodenal GIST, even if the risk is relatively low.
Collapse
Affiliation(s)
- In Woong Han
- Department of Surgery, Dongguk University College of Medicine, Goyang, South Korea,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Aziret M, Çetinkünar S, Aktaş E, İrkörücü O, Bali İ, Erdem H. Pancreatic Gastrointestinal Stromal Tumor after Upper Gastrointestinal Hemorrhage and Performance of Whipple Procedure: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:509-13. [PMID: 26237079 PMCID: PMC4527206 DOI: 10.12659/ajcr.893803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal system. These types of tumors originate from any part of the tract as well as from the intestine, colon, omentum, mesentery or retroperitoneum. GIST is a rare tumor compared to other types of tumors, accounting for less than 1% of all gastrointestinal tumors. CASE REPORT A 56-year-old male patient was hospitalized due to an upper gastrointestinal hemorrhage and the start of abdominal pain on the same day. In the upper gastrointestinal endoscopy that was performed, a solitary mass was found in the second section of the duodenum and a blood vessel (Forrest type 2a) was seen. The extent and location of the mass was detected by abdominal tomography. After hemodynamic recovery, a Whipple procedure was performed without any complications. A subsequent histopathological examination detected a c-kit-positive (CD117) pancreatic GIST with high mitotic index. CONCLUSIONS The most effective treatment method for GISTs is surgical resection. In patients with a head of pancreatic GIST, the Whipple procedure can be used more safely and effectively.
Collapse
Affiliation(s)
- Mehmet Aziret
- Department of General Surgery, Kars State Hospital, Kars, Turkey
| | - Süleyman Çetinkünar
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Elife Aktaş
- Department of Pathology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Oktay İrkörücü
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - İlhan Bali
- Department of General Surgery, Namık Kemal University, Tekirdağ, Turkey
| | - Hasan Erdem
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| |
Collapse
|
|
33
|
Esophageal gastrointestinal stromal tumor: is tumoral enucleation a viable therapeutic option? Ann Surg 2015; 261:117-24. [PMID: 25062398 DOI: 10.1097/sla.0000000000000505] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome. BACKGROUND E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown. METHODS Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared. RESULTS Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors. CONCLUSIONS E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
Collapse
|
|
34
|
Laparoscopic Duodenectomy for Benign Nonampullary Duodenal Neoplasms. Surg Laparosc Endosc Percutan Tech 2015; 25:158-62. [DOI: 10.1097/sle.0000000000000106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
|
35
|
Massive gastrointestinal bleeding caused by a gastrointestinal stromal tumour of the third part of the duodenum treated by means of emergency partial duodenal resection. GASTROENTEROLOGY REVIEW 2015; 10:181-4. [PMID: 26516386 PMCID: PMC4607691 DOI: 10.5114/pg.2015.49106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/12/2014] [Accepted: 10/01/2014] [Indexed: 12/28/2022]
|
|
36
|
Rao BB, Oza VM, Swanson B, Krishna SG. Intratumoral endoscopy and diagnosis of a large gastrointestinal stromal tumor. J Gastrointest Cancer 2014; 45 Suppl 1:140-143. [PMID: 24639237 DOI: 10.1007/s12029-014-9596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Bhavana B Rao
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | | | | |
Collapse
|
|
37
|
Duffaud F, Meeus P, Bachet JB, Cassier P, Huynh TK, Boucher E, Bouché O, Moutardier V, le Cesne A, Landi B, Marchal F, Bay JO, Bertucci F, Spano JP, Stoeckle E, Collard O, Chaigneau L, Isambert N, Lebrun-Ly V, Mancini J, Blay JY, Bonvalot S. Conservative surgery vs. duodeneopancreatectomy in primary duodenal gastrointestinal stromal tumors (GIST): a retrospective review of 114 patients from the French sarcoma group (FSG). Eur J Surg Oncol 2014; 40:1369-75. [PMID: 24994075 DOI: 10.1016/j.ejso.2014.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs. METHODS Patients were identified via a survey from 16 FSG centers (n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation. RESULTS 114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were R0 (n = 87, 79%), R1 (n = 8, 7%), R2 (n = 6). Tumor characteristics were: KIT+ (n = 104), CD34+ (n = 58). Miettinen risk was low (n = 43), and high (n = 52). Imatinib was administered preoperatively (n = 11) and post-operatively (n = 20). With a median follow-up of 36 months (2-250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups (P > 0.05). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse. CONCLUSIONS Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD.
Collapse
Affiliation(s)
- F Duffaud
- Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France.
| | - P Meeus
- Service de Chirurgie, Centre Léon Bérard, Lyon, France
| | - J B Bachet
- Service d'Hépato-gastroentérologie, CHU Pitié Salpétrière, Paris, France
| | - P Cassier
- Service d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - T K Huynh
- Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France
| | - E Boucher
- Service d'Oncologie médicale, Centre Eugène Marquis, Rennes, France
| | - O Bouché
- Service d'Oncologie digestive, CHU de Reims, France
| | - V Moutardier
- Service de Chirurgie digestive, CHU Nord, Marseille, France
| | - A le Cesne
- Service d'Oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - B Landi
- Service de Gastro-entérologie et Oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - F Marchal
- Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France
| | - J O Bay
- Service d'oncologie médicale, CHU Clermont Ferrand, France
| | - F Bertucci
- Service d'Oncologie médicale, Institut Paoli Calmettes, Marseille, France
| | - J P Spano
- Service d'Oncologie médicale, CHU Pitié Salpétrière, Paris, France
| | - E Stoeckle
- Service d'Oncologie médicale, Institut Bergonié, Bordeaux, France
| | - O Collard
- Service d'Oncologie Médicale, CLCC, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
| | - L Chaigneau
- Service d'oncologie médicale, CHU de Besançon, France
| | - N Isambert
- Oncologie médicale, Centre G Leclerc, Dijon, France
| | - V Lebrun-Ly
- Service d'Oncologie médicale, CHU Dijon, France
| | - J Mancini
- Service de Santé Publique et d'Information Médicale, Unité de Biostatistiques, CHU Timone, Marseille, and Aix-Marseille Université (AMU), France
| | - J Y Blay
- Service d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
| | - S Bonvalot
- Service de Chirurgie, Institut G Roussy, Villejuif, France
| |
Collapse
|
|
38
|
Chok AY, Koh YX, Ow MYL, Allen JC, Goh BKP. A Systematic Review and Meta-analysis Comparing Pancreaticoduodenectomy Versus Limited Resection for Duodenal Gastrointestinal Stromal Tumors. Ann Surg Oncol 2014; 21:3429-38. [DOI: 10.1245/s10434-014-3788-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 01/10/2023]
|
|
39
|
Liang X, Yu H, Zhu LH, Wang XF, Cai XJ. Gastrointestinal stromal tumors of the duodenum: Surgical management and survival results. World J Gastroenterol 2013; 19:6000-6010. [PMID: 24106400 PMCID: PMC3785621 DOI: 10.3748/wjg.v19.i36.6000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/25/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide long-term survival results of operable duodenal gastrointestinal stromal tumors (DGISTs) in a tertiary center in China.
METHODS: In this retrospective study, the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery, Sir Run Run Shaw Hospital (SRRSH) from June 1998 to December 2006 were reviewed. All pathological slides were examined by a single pathologist to confirm the diagnosis. In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection, representative paraffin blocks were reassembled, and sections were studied using antibodies against CD117 (c-kit), CD34, smooth muscle actin (SMA), vimentin, S-100, actin (HHF35), and desmin. Operative procedures were classified as wedge resection (WR, local resection with pure closure, without duodenal transection or anastomosis), segmental resection [SR, duodenal transection with Roux-Y or Billroth II gastrojejunostomy (G-J), end-to-end duodenoduodenostomy (D-D), end-to-end or end-to-side duodenojejunostomy (D-J)], and pancreaticoduodenectomy (PD, Whipple operation with pancreatojejunostomy). R0 resection was pursued in all cases, and at least R1 resection was achieved. Regional lymphadenectomy was not performed. Clinical manifestations, surgery, medical treatment and follow-up data were retrospectively analyzed. Related studies in the literature were reviewed.
RESULTS: There were 12 males and 16 females patients, with a median age of 53 years (20-76 years). Their major complaints were “gastrointestinal bleeding” (57.2%) and “nonspecific discomfort” (32.1%). About 14.3%, 60.7%, 17.9%, and 7.1% of the tumors originated in the first to fourth portion, respectively, with a median size of 5.8 cm (1.6-20 cm). Treatment was by WR in 5 cases (17.9%), SR in 13 cases (46.4%), and by PD in 10 cases (35.7%). The morbidity and mortality rates were 35.7% and 3.6%, respectively. The median post-operative stay was 14.5 d (5-47 d). During a follow-up of 61 (23-164) mo, the 2-year and 5-year relapse-free survival was 83.3% and 50%, respectively. Eighty-four related articles were reviewed.
CONCLUSION: Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved. Comprehensive treatment is necessary.
Collapse
|
|
40
|
Yang F, Jin C, Du Z, Subedi S, Jiang Y, Li J, Di Y, Zhou Z, Tang F, Fu D. Duodenal gastrointestinal stromal tumor: clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg 2013; 206:360-367. [PMID: 23673012 DOI: 10.1016/j.amjsurg.2012.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 10/29/2012] [Accepted: 11/06/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) occur rarely in the duodenum. Because of their low incidence, data on long-term survival and prognostic factors are limited. The aims of this study were to present the authors' experiences in the diagnosis and treatment of this disease and to evaluate long-term surgical outcomes. METHODS Clinical data from 22 consecutive patients with duodenal GISTs surgically managed from May 1999 to August 2011 were retrospectively studied. A pooled analysis was done by systematically reviewing other case series reported in the English literature. Recurrence-free survival and independent predictors of adverse outcomes were analyzed using the Kaplan-Meier method and multivariate Cox regression. RESULTS Duodenal GISTs had a mild male predominance (68.2%), occurring primarily in older adults (median age, 58 years), with a frequency of 7.49% among all GISTs. Clinical presentations were nonspecific, with gastrointestinal bleeding and abdominal pain or discomfort being the most common symptoms. The tumors were located mainly in the second portion of the duodenum, in 14 patients (63.6%), with a median size of 3.75 cm (range, 1.4 to 14). All patients underwent curative surgical resection, including 9 pancreaticoduodenectomy, 3 segmental duodenectomy, and 10 local resection. Eighteen patients were alive without evidence of recurrence after a median follow-up period of 67.5 months (range, 3 to 118). The 1-year, 2-year, and 3-year rates of recurrence-free survival were 95%, 89.5%, and 86.7%, respectively. Kaplan-Meier analysis and log-rank tests showed that surgical pattern, mitosis, and risk grade were significantly associated with recurrence-free survival (P < .05 for all). However, only high mitosis was a significant predictive factor for adverse outcomes on multivariate analysis (hazard ratio, 16.414; 95% confidence interval, 1.914 to 140.756; P = .011). CONCLUSIONS Duodenal GIST is an unusual neoplasm with favorable survival after curative resection. Mitotic activity was more influential than tumor size and risk grade in predicting adverse outcomes. All patients with duodenal GISTs require long-term follow-up, because late relapse can occur even if the tumor has low malignant potential.
Collapse
Affiliation(s)
- Feng Yang
- Pancreatic Disease Institute, Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Zhou B, Zhang M, Wu J, Yan S, Zhou J, Zheng S. Pancreaticoduodenectomy versus local resection in the treatment of gastrointestinal stromal tumors of the duodenum. World J Surg Oncol 2013; 11:196. [PMID: 23945012 PMCID: PMC3751193 DOI: 10.1186/1477-7819-11-196] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 08/04/2013] [Indexed: 02/07/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. However, duodenal GISTs compromise a small and rare subset and few studies have focused on them. We evaluated the surgical management of patients with duodenal GISTs treated by pancreaticoduodenectomy (PD) versus local resection (LR) in our institution and analyzed the postoperative outcomes. Methods This was a retrospective review of patients with duodenal GISTs managed in our institution from January 2006 to January 2012. Clinicopathologic findings and disease-free survival (DFS) of duodenal GIST patients were analyzed. Results A total of 48 patients were selected. The most common presentation was bleeding (60.4%), and the second portion of the duodenum (35.4%) was the most common dominant site. Of the patients, 34 (70.8%) underwent LR while 14 (29.2%) underwent PD. The surgical margins for all studied patients were free. Patients who ultimately underwent PD were more likely to present with a larger tumor (median size: PD, 6.3 cm vs LR, 4.0 cm; P = 0.02) and more commonly presented with a tumor in the second portion of the duodenum (second portion: PD, 64.3% vs LR, 23.5%; P = 0.007). The tumors treated by PD had a higher grade of risk compared with LR as defined by National Institutes of Health (NIH) criteria (P = 0.019). PD was significantly associated with a longer operation time and a longer hospital stay compared to LR (P < 0.001 and P = 0.001, respectively). In our study, the median follow-up period was 36 months (range: 0 to 81 months). The 1- and 3-year DFS was 100% and 88%, respectively. From multivariable analysis, the only significant factor associated with a worse DFS was an NIH high risk classification (hazard ratio = 4.24). Conclusions The recurrence of duodenal GIST was correlated to tumor biology rather than type of operation. PD was associated with a longer hospital stay and longer operation time. Therefore, LR with clear surgical margins should be considered a reliable and curative option for duodenal GIST and PD should be reserved for lesions not amenable to LR.
Collapse
|
|
42
|
Duodenal wedge resection for large gastrointestinal stromal tumour presenting with life-threatening haemorrhage. Case Rep Gastrointest Med 2013; 2013:562642. [PMID: 23634309 PMCID: PMC3619631 DOI: 10.1155/2013/562642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022] Open
Abstract
Background. Duodenal gastrointestinal stromal tumours (GISTs) are an uncommon malignancy of the gastrointestinal (GI) tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.
Collapse
|
|
43
|
Duodenal gastrointestinal stromal tumors (GISTs): arguments for conservative surgery. J Gastrointest Surg 2013; 17:482-7. [PMID: 23229887 DOI: 10.1007/s11605-012-2075-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/29/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) of the duodenum are rare. We sought to evaluate the postoperative courses and long-term outcomes of conservative surgery (CS) versus pancreaticoduodenectomy (PD) for patients with non-metastatic duodenal GISTs. METHODS Seventeen patients underwent surgery for duodenal GISTs between January 2000 and January 2012; 11 patients underwent CS (CS group), and six patients underwent a PD (PD group). RESULTS Mortality was similar between the two groups. Patients in the PD group had longer operative times, more tumors located on the pancreatic side of the duodenum, higher rates of post-operative complications including postoperative pancreatic fistulas, and a longer hospital stay, when compared with patients of CS group. All tumors were resected with clear surgical margins (R0 resection). The median disease-free survival times were not different. CONCLUSION CS was safe and provided similar oncologic outcomes as PD. CS should be the procedure of choice in patients with GIST that does not involve the pancreatic side of the duodenum.
Collapse
|
|
44
|
A duodenal stromal tumor mimicking a pancreatic head tumor: one case report and literature review. Eur Surg 2013. [DOI: 10.1007/s10353-012-0176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
|
45
|
Beham A, Schaefer IM, Cameron S, von Hammerstein K, Füzesi L, Ramadori G, Ghadimi MB. Duodenal GIST: a single center experience. Int J Colorectal Dis 2013; 28:581-90. [PMID: 22350270 PMCID: PMC3639365 DOI: 10.1007/s00384-012-1432-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The duodenum as primary site for gastrointestinal stromal tumors (GISTs) is rare and mitotic rate, tumor size, type of mutation and number of chromosomal aberrations have prognostic implications. METHODS We analyzed the outcome of 13 patients with duodenal GISTs who underwent surgical tumor resection. Either segmental duodenectomy or pylorus-preserving duodenopancreatectomy was performed. The tumors were histopathologically examined and the risk of progression was assessed based on tumor size and mitotic count. Additionally, mutation analysis of the KIT and PDGFRA receptor tyrosine kinase genes and comparative genomic hybridization (CGH) were performed in all cases. RESULTS Eight patients underwent segmental duodenectomy and five patients were treated with pylorus-preserving duodenopancreatectomy. None of the five GISTs with low or no risk for malignancy according to the Miettinen classification developed tumor progress. In contrast, five of eight cases (62.5%) with high-risk tumors revealed tumor progress, and four of these patients died (50%). The median overall survival for all patients was 66 months, and the median disease-free survival 41 months. The operative procedure and type of mutation did not correlate with long-term survival. CGH analysis displayed -15q in 12/13 tumors, and -1p in 11/13 cases as characteristic chromosomal aberrations for intestinal origin. Notably, -22q was present in three of four cases with tumor progress. CONCLUSIONS Both segmental duodenectomy and pylorus-preserving duodenopancreatectomy are appropriate options to treat duodenal GIST and should be implemented depending on resectability and the patient's performing state. The Miettinen classification and CGH findings correlate with the clinical course.
Collapse
Affiliation(s)
- Alexander Beham
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Silke Cameron
- Department of Gastroenterology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Laszlo Füzesi
- Department of Pathology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Giuliano Ramadori
- Department of Gastroenterology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael B. Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
|
46
|
Kamath AS, Sarr MG, Nagorney DM, Que FG, Farnell MB, Kendrick ML, Reid Lombardo KM, Donohue JH. Gastrointestinal stromal tumour of the duodenum: single institution experience. HPB (Oxford) 2012; 14:772-6. [PMID: 23043666 PMCID: PMC3482673 DOI: 10.1111/j.1477-2574.2012.00535.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary gastrointestinal stromal tumours (GISTs) of the duodenum are rare. The aim of this study was to review the surgical management of GISTs in this anatomically complex region. METHODS Retrospective review from January 1999 to August 2011 of patients with primary GISTs of the duodenum. RESULTS Forty-one patients underwent resection of duodenal GISTs. All operations were performed with intent to cure with negative margins of resection. The most common location of origin was the second portion of the duodenum. Local excision (n= 19), segmental resection with primary anastomosis (n= 11) and a pancreatoduodenectomy (n= 11) were performed. Two patients underwent an ampullectomy with local excision. Peri-operative mortality and overall morbidity were 0 and 12, respectively. Patients with high-risk GISTs (P= 0.008) and those who underwent a pancreatoduodenectomy (P= 0.021) were at a greater risk for morbidity. The median follow-up was 18 months. Eight patients developed recurrence. High-risk GISTs and neoplasms with ulceration had the greatest risk for recurrence (P= 0.017, P= 0.029 respectively). The actuarial 3- and 5-year survivals were 85% and 74%, respectively. CONCLUSION The choice and type of resection depends on the proximity to the ampulla of Vater, involvement of adjacent organs and the ability to obtain negative margins. The morbidity depends on the type of procedure for GIST.
Collapse
Affiliation(s)
- Ashwin S Kamath
- Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, MN, USA
| | | | | | | | | | | | | | | |
Collapse
|
|
47
|
Cavallaro G, Polistena A, Pedullà G, Iorio O, D'Ermo G, De Toma G. Management of Exophytic Gastrointestinal Stromal Tumors Arising in the Duodenopancreatic Region. Am Surg 2012. [DOI: 10.1177/000313481207801112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies Sapienza University Rome, Italy
| | - Andrea Polistena
- Department of Surgery “P. Valdoni” Sapienza University Rome, Italy
| | - Giuseppe Pedullà
- Department of Surgery “P. Valdoni” Sapienza University Rome, Italy
| | - Olga Iorio
- Department of Medico-Surgical Sciences and Biotechnologies Sapienza University Rome, Italy
| | - Giuseppe D'Ermo
- Department of Surgery “P. Valdoni” Sapienza University Rome, Italy
| | - Giorgio De Toma
- Department of Surgery “P. Valdoni” Sapienza University Rome, Italy
| |
Collapse
|
|
48
|
Colombo C, Ronellenfitsch U, Yuxin Z, Rutkowski P, Miceli R, Bylina E, Hohenberger P, Raut CP, Gronchi A. Clinical, pathological and surgical characteristics of duodenal gastrointestinal stromal tumor and their influence on survival: a multi-center study. Ann Surg Oncol 2012; 19:3361-3367. [PMID: 22843188 DOI: 10.1245/s10434-012-2559-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND The duodenum is a rare site of primary gastrointestinal stromal tumor (GIST). Overall (OS) and disease-free survival (DFS) after limited resection (LR) versus pancreaticoduodenectomy (PD) were studied. METHODS All patients who underwent surgery for primary, localized duodenal GIST between 2000 and 2011 were identified from four prospective institutional databases. OS and DFS were calculated by Kaplan-Meier method. Univariate analysis was performed. RESULTS Eighty-four patients (median follow-up 42 months) underwent LR (n = 56, 67%) or PD (n = 28, 33%). Patients in the PD group had a larger median tumor size (7 cm vs. 5 cm, p = 0.024) and higher mitotic count (39% vs. 19% >5/50 high-power fields, p = 0.05). Complications were observed in five patients (9%) in the LR group and ten patients (36%) in the PD group. OS and DFS for the entire cohort were 89% and 64% at 5 years, respectively. No difference in outcome between LR and PD were observed. Eleven patients were treated with preoperative IM. A major RECIST response was obtained in nine (80%), whereas two had stable disease. Twenty-three patients received postoperative Imatinib (IM). A trend toward a better OS in IM-treated patients could be detected only in the high-risk group. CONCLUSIONS Type of duodenal resection does not impact outcome. The choice should be determined by duodenal site of origin and tumor size. IM may be considered in cases at high risk of recurrence; in neoadjuvant setting, IM might facilitate resection and possibly increase the chance of preserving normal biliary and pancreatic anatomy.
Collapse
Affiliation(s)
- C Colombo
- Department of Surgery, Sarcoma Service, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
Cavallaro G, Polistena A, D'Ermo G, Pedullà G, De Toma G. Duodenal gastrointestinal stromal tumors: review on clinical and surgical aspects. Int J Surg 2012; 10:463-5. [PMID: 22939976 DOI: 10.1016/j.ijsu.2012.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/14/2012] [Accepted: 08/21/2012] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) arising in the duodenum represent a rare entity and can be very demanding to manage. The diagnosis can be difficult (as these tumors can be misdiagnosed as pancreatic head tumors), and to treat owing to the complex anatomy of the duodenum and of the pancreatic head. Complete resection may require extensive procedures such as pancreaticodudodenectomy. METHODS AND RESULTS An extensive literature review regarding clinico-pathological features, diagnostic investigations and surgical options in the management of duodenal GISTs has been performed. CONCLUSIONS Duodenal GISTs have uncertain malignant potential, and they may be asymptomatic, or present with abdominal pain or bleeding. A preoperative diagnosis can be difficult to obtain. Endoscopic ultrasound and fine needle aspiration cytology (FNAC) may be helpful. Surgical R0 resection remains the only curative approach. However, owing to the complex anatomy of the duodenum, limited resection is not always feasible. In these cases, extensive procedures such as pancreaticoduodenectomy or pancreas-preserving duodenectomy are the treatment of choice.
Collapse
Affiliation(s)
- G Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.
| | | | | | | | | |
Collapse
|
|
50
|
Johnston FM, Kneuertz PJ, Cameron JL, Sanford D, Fisher S, Turley R, Groeschl R, Hyder O, Kooby DA, Blazer D, Choti MA, Wolfgang CL, Gamblin TC, Hawkins WG, Maithel SK, Pawlik TM. Presentation and management of gastrointestinal stromal tumors of the duodenum: a multi-institutional analysis. Ann Surg Oncol 2012; 19:3351-60. [PMID: 22878613 DOI: 10.1245/s10434-012-2551-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GISTs) are a small subset of GISTs, and their management is poorly defined. We evaluated surgical management and outcomes of patients with duodenal GISTs treated with pancreaticoduodenectomy (PD) versus local resection (LR) and defined factors associated with prognosis. METHODS Between January 1994 and January 2011, 96 patients with duodenal GISTs were identified from five major surgical centers. Perioperative and long-term outcomes were compared based on surgical approach (PD vs LR). RESULTS A total of 58 patients (60.4%) underwent LR, while 38 (39.6%) underwent PD. Patients presented with gross bleeding (n = 25; 26.0%), pain (n = 23; 24.0%), occult bleeding (n = 19; 19.8%), or obstruction (n = 3; 3.1%). GIST lesions were located in first (n = 8, 8.4%), second (n = 47; 49%), or third/fourth (n = 41; 42.7%) portion of duodenum. Most patients (n = 86; 89.6%) had negative surgical margins (R0) (PD, 92.1 vs LR, 87.9%) (P = 0.34). Median length of stay was longer for PD (11 days) versus LR (7 days) (P = 0.001). PD also had more complications (PD, 57.9 vs LR, 29.3%) (P = 0.005). The 1-, 2-, and 3-year actuarial recurrence-free survival was 94.2, 82.3, and 67.3%, respectively. Factors associated with a worse recurrence-free survival included tumor size [hazard ratio (HR) = 1.09], mitotic count >10 mitosis/50 HPF (HR = 6.89), AJCC stage III disease (HR = 4.85), and NIH high risk classification (HR = 4.31) (all P < 0.05). The 1-, 3-, and 5-year actuarial survival was 98.3, 87.4, and 82.0%, respectively. PD versus LR was not associated with overall survival. CONCLUSIONS Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. PD was associated with longer hospital stays and higher risk of perioperative complications. When feasible, LR is appropriate for duodenal GIST and PD should be reserved for lesions not amenable to LR.
Collapse
Affiliation(s)
- Fabian M Johnston
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|