Gastrointestinal Stromal Tumors of Pancreas and Duodenum - Challenges in Their Diagnosis and Surgical Treatment

Abstract

Introduction: Although gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract, they constitute less than 1% of all cancers of the digestive tube. Only 4-5% of these are located in the duodenum and GISTs in the pancreas, omentum and retroperitoneum are extremely rare. Diagnosis of pancreatic or duodenal GIST is often difficult because formation resembles pancreatic cancer clinically or on the imaging tests.Aim: The aim of this paper is to make a detailed review of the literature regarding the surgical treatment of duodenal and pancreatic GISTs and to present the observed cases in our practice comparing them with the patients with other locations of the process. Materials and Methods: A retrospective study covering the period 2005 - 2015 was carried out in the University Hospital `Alexandrovska`. It included 50 patients who underwent surgery for GIST. Two of patients were diagnosed with duodenal GIST, and in one case - GIST arising from the left pancreas was found. In cases with a pancreatic tumor location, a distal pancreatectomy with splenectomy was performed. A partial resection of the duodenum and a pancreatoduodenectomy were carried out respectively, in the cases of duodenal GIST. Literature review was made on the basis of recent publications referenced in Medline, PubMed and Google scholar. Results and Conclusions: GISTs, and in particular those with pancreatic and duodenal localization, may have varying malignant potential. Surgical removal of the tumor in clear resection margins is the only method providing a cure. Sometimes, this can be achieved through a relatively limited resection in tight. In most cases, however, a pancreatoduodenectomy needs to be done given the mistaken interpretation of the tumor as pancreatic cancer and due to the anatomical connection between the pancreas, the duodenum, and the bile ducts.