Abstract
BackgroundGastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. However, duodenal GISTs compromise a small and rare subset and few studies have focused on them. We evaluated the surgical management of patients with duodenal GISTs treated by pancreaticoduodenectomy (PD) versus local resection (LR) in our institution and analyzed the postoperative outcomes.MethodsThis was a retrospective review of patients with duodenal GISTs managed in our institution from January 2006 to January 2012. Clinicopathologic findings and disease-free survival (DFS) of duodenal GIST patients were analyzed.ResultsA total of 48 patients were selected. The most common presentation was bleeding (60.4%), and the second portion of the duodenum (35.4%) was the most common dominant site. Of the patients, 34 (70.8%) underwent LR while 14 (29.2%) underwent PD. The surgical margins for all studied patients were free. Patients who ultimately underwent PD were more likely to present with a larger tumor (median size: PD, 6.3 cm vs LR, 4.0 cm; P = 0.02) and more commonly presented with a tumor in the second portion of the duodenum (second portion: PD, 64.3% vs LR, 23.5%; P = 0.007). The tumors treated by PD had a higher grade of risk compared with LR as defined by National Institutes of Health (NIH) criteria (P = 0.019). PD was significantly associated with a longer operation time and a longer hospital stay compared to LR (P < 0.001 and P = 0.001, respectively). In our study, the median follow-up period was 36 months (range: 0 to 81 months). The 1- and 3-year DFS was 100% and 88%, respectively. From multivariable analysis, the only significant factor associated with a worse DFS was an NIH high risk classification (hazard ratio = 4.24).ConclusionsThe recurrence of duodenal GIST was correlated to tumor biology rather than type of operation. PD was associated with a longer hospital stay and longer operation time. Therefore, LR with clear surgical margins should be considered a reliable and curative option for duodenal GIST and PD should be reserved for lesions not amenable to LR.
Highlights
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms
Clinicopathologic characteristics of duodenal gastrointestinal stromal tumors In total, 48 patients who had presented with duodenal GISTs during the study period were included in the analysis (28 men, 20 women)
The duodenal GISTs were located at the first (D1) (n = 11, 22.9%), second (D2) (n = 17, 35.4%), third (D3) (n = 6, 12.5%) or fourth portion of the duodenum (D4) (n = 2, 4.2%), or they involved both First part of the duodenum (D1)/Second part of the duodenum (D2) (n = 8, 16.7%) or D2/Third part of the duodenum (D3) (n = 4, 8.3%)
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. duodenal GISTs compromise a small and rare subset and few studies have focused on them. We evaluated the surgical management of patients with duodenal GISTs treated by pancreaticoduodenectomy (PD) versus local resection (LR) in our institution and analyzed the postoperative outcomes. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. They can occur in the stomach (45% to 65%), small intestine (15% to 25%), colon and rectum (5% to 10%) or esophagus (5% to 10%) [1]. We retrospectively reviewed the clinicopathologic characteristics of duodenal GISTs in our institution and compared the outcomes of patients undergoing PD versus LR with the main objective of determining if LR is a viable treatment option for these tumors
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