Clinicopathological and Prognostic Features of Surgical Management in Duodenal Gastrointestinal Stromal Tumors

Abstract

Background and Objectives: The rarity of duodenal gastrointestinal stromal tumors (DGIST) led to only limited data being available on their management and prognosis. We retrospectively analyzed the clinicopathological features, surgical treatments, adjuvant therapy, and prognosis of DGIST. Methods: Sixty-one patients were identified at diagnosis of primary DGIST from February 2005 to December 2015. One hundred twenty six patients with small intestinal gastrointestinal stromal tutors (GIST) were selected as control groups. Survival analyses were calculated using the Kaplan-Meier method. Results: Three- and five-year recurrence/metastasis-free survival rates of patients with DGIST were similar to those of patients with small intestinal GIST (p > 0.05 for all). Out of 61 cases with DGIST, 45 patients were treated with Limited Resection (LR). Sixteen patients were treated with Pancreaticoduodenectomy (PD). The 3- and 5-year recurrence/metastasis-free survival rates of the PD group and LR group were of no significant difference (p > 0.05 for all). Univariate analysis indicated that factors including surgical approaches, mitotic count, size, and risk grades were significantly associated with recurrence/metastasis-free survival (log-rank test, p < 0.05). Multivariate analysis demonstrated that the mitotic count was independently correlated with a worse recurrence/metastasis-free survival. Conclusions: Patients with radical resected DGIST had a favourable prognosis, which is similar to that of small intestinal GIST. Both LR and PD were optimal choices for treating DGIST.

Staged surgical approach for metastatic GIST, how far should we go? Case report

“…The management of duodenal GIST (DGIST) varies depending on the stage of the disease, where the standard line of treatment for a localized DGIST is surgical resection with negative margins without the need for lymphadenectomy, as submucosal and the subsequent lymph node involvement are rarely present. Localized DGIST usually carries a good prognosis [ 10 , 11 ]. Nonetheless, even a localized DGIST may represent a surgical challenge due to the complexity of the anatomy involved and the close proximity to vital organs.…”

“…Whipple or limited resection. On the other hand, advanced disease, especially involving the liver, may elevate the challenge and raise controversy regarding the best course of action in such cases [ 11 , 12 ].…”

“…Currently, with the advancements in surgical approaches and perioperative care, liver resection might be a curative option when complete surgical excision is possible. Moreover, the utilization of neoadjuvant TKIs – like Imatinib – have facilitated the role of surgery, particularly in patients with unresectable liver metastasis, and even reduced the need for extensive resection in difficult anatomical locations like the duodenum, where pancreaticoduodenectomy can be avoided by limited duodenal resection [ 10 , 11 , 12 ].…”

Current surgical management of duodenal gastrointestinal stromal tumors

“…When counselling the patients with D-GISTs for surgical resection, it is important to provide the information on the overall morbidity rate, which ranges from 8.2%-33.3% in LR group and 21.4%-88.9% in PD group, whilst the mortality rate is about 3.6%-6.0%[ 23 , 36 , 54 , 56 , 64 ].…”

Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis

“…Some studies demonstrated that compared with limited resection (LR), pancreaticoduodenectomy (PD) could achieve a wider margin, alleviating the hazard of positive margins and local recurrence [9, 11, 18]. Despite the possibility of recurrence, many surgeons still recommended the routine use of LR, which can preserve pancreatic function and gastrointestinal continuity, thereby reducing postoperative complications and accelerating the recovery of digestive capability [15, 19, 20]. However, the controversy reaches far beyond that.…”