Organ-preserving surgery for locally advanced duodenal gastrointestinal stromal tumor after neoadjuvant treatment

Lv, Ang; Qian, Hong-Gang; Qiu, Hui; Wu, Jianhui; Li, Ying; Li, Zhongwu; Hao, Chunyi

doi:10.5582/bst.2017.01183

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…Lack of DOG-1 expression was associated with poor prognosis in a recent study with 332 patients (93). The differential diagnosis includes f i b r o m a t o s i s ( 1 1 0 ) , s c h w a n n o m a s , l e i o m y o m a s , inflammatory fibroid tumors, solitary fibrous tumor, mesenteric sclerosing fibrotic lesions, sarcomas, metastasis from malignant melanoma, glomus tumors, paragangliomas, ectopic pancreas (65,92,98).…”

Section: Histopathology and Molecular Characteristicsmentioning

confidence: 99%

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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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.

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Section: Histopathology and Molecular Characteristicsmentioning

confidence: 99%

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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“…Tumour rupture should be avoided as much as possible during DGIST resection because it is a high-risk factor for postoperative recurrence and metastasis [3,5,[7][8][9][10][11]. Tumours located in the horizontal segment of the duodenum are often closely related to the superior mesenteric vein and superior artery.…”

Section: Discussionmentioning

confidence: 99%

“…Duodenal gastrointestinal stromal tumours (DGISTs) are independent undifferentiated mesenchymal tumours, and they only account for 2-5% of all gastrointestinal stromal tumours [1][2][3][4][5]. Surgical resection is the most effective treatment for DGIST [6,7].…”

Section: Introductionmentioning

confidence: 99%

Robotic Resection of Duodenal Gastrointestinal Stromal Tumour: Preliminary Experience from a Single Centre

Zhou

Tan

Zhao

et al. 2021

Preprint

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Background: The experience of minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumours (DGISTs) is accumulating, but there is no consensus on the choice of surgical method. The purpose of this study is to summarize the technique and feasibility of robotic resection of DGIST.Methods: The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGIST between May 1, 2010 and May 1, 2020 were retrospectively analysed. Patients were divided into an open surgery group and a robotic surgery group. Pancreaticoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.Results: Among the 28 patients, there were 19 males and 9 females aged 51.3± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (p>0.05). OT and EBL in the robotic group were significantly different from those in the open surgery group (p<0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (p>0.05).Conclusions: Robotic resection is safe and feasible for patients with duodenal gastrointestinal stromal tumours, and its therapeutic effect is equivalent to open surgery.

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“…With regard to metastatic and/or recurrent GIST, in the pre-IM era, surgery for patients with metastatic and/or recurrent GIST was not associated with a favorable outcome, which has been significantly changed with introduction of adjuvant IM treatment. [ 5 , 21 , 22 ] However, it is apparent that most patients who initially response to IM treatment eventually acquire secondary progression, and median time from disease control to progression is approximately less than 2 years reported by some previous large clinical trials. [ 23 ] The purpose of surgical resection of recurrent and/or metastatic lesions that response to IM is to prevent potential development of secondary mutations which is believed the main cause of progression.…”

Section: Discussionmentioning

confidence: 99%

Preoperative imatinib treatment in patients with locally advanced and metastatic/recurrent gastrointestinal stromal tumors

Wang

Yin²,

Shen³

et al. 2020

Medicine

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The advent of imatinib mesylate (IM) has dramatically revolutionized the prognosis of advanced and metastatic/recurrent gastrointestinal stromal tumors (GISTs). The objective of this retrospective study is to investigate the safety and efficacy of combination of surgery following IM treatment in the management of advanced and metastatic/recurrent GISTs. We further explore the long-term clinical outcomes in these who underwent therapy of preoperative IM. Eligible patients with GISTs before the onset of the IM therapy and were periodically followed up in the outpatient clinic were included in this study. Detailed clinical and pathologic characteristics were obtained from the medical records of our institution. Univariate and multivariate regression analyses were performed to use for the evaluation of potential prognostic factors. A total of 51 patients were included in the study, of these patients, 36 patients underwent surgery and median duration of preoperative IM is 8.2months (range 3.5–85 months). Significant median tumor shrinkage rate was 29.27% (95% confidence interval 21.00%–34.00%) observed in these patients who responded to IM, and partial response and stable disease were achieved in 24 patients (47.06%) and 23 patients (45.10%), respectively, in light of the RECIST guideline (version 1.1). After the median follow-up of 43.70 months (range 14.2–131.1 months), 1- and 3-year overall survival (OS) were estimated to be 96.1% and 94.0%, respectively, and there was a significant improvement in OS for patients who received surgical intervention versus those who did not. Our study consolidates that patients were received preoperative IM therapy could shrink the size of tumors and facilitate organ-function preservation. The long-term analysis on this study supports that surgical intervention following IM therapy benefits for patients with primary advanced and recurrent or metastatic GISTs on long-term prognosis.

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Organ-preserving surgery for locally advanced duodenal gastrointestinal stromal tumor after neoadjuvant treatment

Cited by 14 publications

References 29 publications

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Robotic Resection of Duodenal Gastrointestinal Stromal Tumour: Preliminary Experience from a Single Centre

Preoperative imatinib treatment in patients with locally advanced and metastatic/recurrent gastrointestinal stromal tumors

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