Duodenal gastrointestinal stromal tumors: A retrospective study based on a 13 years experience of a single center in China.

Abstract

Duodenal gastrointestinal stromal tumors (GISTs) constitute a small rare subset. This study aims to analyze the prognostic differences between duodenal and jejunoileal GISTs and evaluate the clinical treatment and prognostic characteristics of patients with duodenal GISTs. Data of patients with primary duodenal or jejunoileal GISTs were collected. Patients were matched through propensity score matching (PSM). Perioperative and long-term outcomes of patients with duodenal GISTs were compared based on surgical approach. Altogether, 101 duodenal and 219 jejunoileal GISTs were identified. In patients with duodenal GISTs, 79 (78%) underwent local resection (LR) and 22 (22%) underwent pancreaticoduodenectomy (PD). Patients undergoing PD had a longer postoperation stay (18.5vs 13 days, P=0.001) and more complications (Clavien-Dindo I-II complications for PD vs LR, 31.8vs 15.2%; Clavien-Dindo III-V complications for PD vs LR, 22.7vs. 2.5%; P<0.001). There was no difference in recurrence-free survival (RFS) (P=0.8) or overall survival (OS) (P=0.9) when comparing patients who underwent LR versus PD. Multivariable analysis showed that tumor size>5cm was the only independent predictor of shorter RFS (P=0.004) and OS (P=0.012). After matching, there was no significant difference in RFS and OS between patients with duodenal versus jejunoileal GISTs (both P>0.05). The prognosis of duodenal and jejunoileal GISTs are similar. Recurrence and OS of duodenal GISTs primarily depend on tumor size. For duodenal GISTs, LR is associated with comparable long-term survival when compared to PD, but with superior short-term outcomes.