Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome.

Chaoyong Shen,Luyin Han,Haining Chen,Bo Zhang,Jiaping Chen,Zhixin Chen,Jiaju Chen,Yuan Yin

doi:10.1186/s12893-015-0084-3

Chaoyong Shen, Luyin Han + Show 6 more

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https://doi.org/10.1186/s12893-015-0084-3

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Abstract

BackgroundDuodenal 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.MethodsData 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.ResultsOut 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).ConclusionsDGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.

Highlights

Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited
Mazur and Clark re-evaluated the histogenesis of gastrointestinal stromal tumors (GIST) in 1983, and following research has confirmed that GIST are the most common mesenchymal tumors [1,2,3,4]
Inclusion criteria are as follows: (1)Patients who underwent laparotomy; (2)Patients with DGIST, as proven by pathological, immunohistochemical, and gene mutation detection examinations; (3)The tumor was located in the duodenum, as confirmed by preoperative abdominal CT scan, ultrasound endoscopy, upper gastrointestinal barium swallow radioscopy, and operation; (4)Patients with GIST synchronous with other malignancies were excluded in this study

Summary

Introduction

Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. GIST can originate within the entire gastrointestinal tract, the most common location is the stomach (approximately 60 %), followed by the small intestine (about 20–30 %), and rarely in the Primary GIST is categorized into very low, low, intermediate, and high risk based on a previous study of Fletcher [8]. Subsequent studies have shown that GIST have different clinical, histological, and immunohistochemical features due to different tumor locations; Shen et al BMC Surgery (2015) 15:98 this difference is one of the independent risk factors for tumor recurrence [9, 10]. The main concern on WR or SR is increased risk of tumor recurrence because of incomplete resection [7]

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