Feasibility and Oncological Outcomes of Limited Duodenal Resection in Patients with Primary Nonmetastatic Duodenal GIST

Abstract

IntroductionDuodenal gastrointestinal stromal tumors (GISTs) are rare but still represent approximately 30 % of primary duodenal tumors. This study aimed to audit the feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. MethodsTwelve patients who underwent surgery at our institution since 2002 were prospectively followed up. The duodenal GISTs were located in the first (n = 3), second (n = 1), third (n = 3), and fourth of duodenum (n = 1). Involving both D1/D2 (n = 2), D2/D3 (n = 1), and D3/D4 (n = 1). The primary endpoint for this analysis was disease-free survival. ResultsThe commonest presentation was melena and anemia (83 %). All the patients underwent limited resection; six wedge resections with primary closures and six segmental resections with end-to-end anastomosis. The median tumor size was 8 cm (range, 5–16 cm). According to Fletcher scale, two GISTs were low risk, while 10 patients were intermediate and high risk. The latter received adjuvant therapy. All the patients had a complete resection with no postoperative mortality. One patient had three liver metastases 4 months after limited resection and had partial hepatectomy. After median follow-up of 45 (15–78) months, all patients are alive and disease free. Conclusion(s)When technically feasible, limited resection should be considered a reliable and curative option for duodenal GIST achieving satisfactory disease-free survival. The technical feasibility is guided by the tumor size, possible adjacent organ involvement, and its exact anatomical location.