Duodenal Gastrointestinal Tumor Research Articles

HEMORRAGIE DIGESTIVE ABONDANTE REVELANT UNE TUMEUR DUODENALE: A PROPOS D1 CAS AU SERVICE URGENCE-DECHOQUAGE CHU MOHAMED VI MARRAKECH

Duodenal gastrointestinal tumors are very rare. Represents approximately 2% of grelic tumors [1]. The discovery is often fortuitous, through chronically evolving digestive symptoms (epigastric pain, digestive disorder, abdominal pain, mass,) or through intermittent digestive bleeding complicated by anemia [2]. But the discovery of a large digestive hemorrhage generally poses a major problem of diagnosis and emergency management because it requires adequate emergency treatment and sometimes emergency hemostasis measures. We report the observation of a duodenal tumor, revealed by a large digestive hemorrhage with hemodynamic impact in a 35-year-old male patient.

Outcome after Surgical Treatment of Gastrointestinal Stromal Tumors in the Second Part of Duodenum: Is Localized Resection Appropriate?

Background The second part of the duodenum is the most common part to be involved with duodenal gastrointestinal tumors (D2-GISTs). Localized resection (LR) and pancreaticoduodenectomy (PD) are two viable options for curative resection. The aim of this study is to compare the middle-term outcomes in patients with D2-GIST after either LR or PD in a single institution. Patients and Methods Overall, 53 patients with non-metastatic D2-GIST were analyzed. Either LR or PD was executed depending on the involvement of the ampulla of Vater. The tumors were stratified in accordance with the Miettinen classification for tumor behavior. The patients were followed up for 3 years for recurrence and survival. Results Thirty-two of the patients were females (60%) and 21 males (40%), with a mean age of 55 ± 8 years. Bleeding was the most common presentation in 19 patients (36%). LR was performed in 41 patients (77%), whereas PD was performed in 12 patients (23%). Three-year survival and recurrence were comparable between the two groups. The disease-free survival at 3 years was 85% and 92% in LR and PD group, respectively. The PD group had a significantly longer operative time and a higher incidence of postoperative pancreatic fistula. Otherwise, no statistically significant difference was calculated. A significantly shorter survival was calculated in those with a mitotic index of >5 and also for tumors classified as high grade in accordance with the Miettinen classification. 71% of those with recurrence had high mitotic index > 5/hpf. Conclusions LR for D2-GIST is an acceptable alternative to PD with satisfactory middle-term outcomes. For tumors involving the ampulla of Vater, PD is still indicated. Furthermore, tumor biology predicts the likelihood of survival and recurrence.

The clinicopathologic features and optimal surgical treatment of duodenal gastrointestinal tumor.

519 Background: Because of unclear clinicopathologic features, the optimal surgical procedure for duodenal gastrointestinal stromal tumor (GIST) remains poorly defined. We analyze clinicopathological features and recommend optimal surgical treatment of duodenal GIST. Methods: From July, 2000 to April 2017, 118 patients who had localized duodenal GIST were treated by curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes. Results: In survival analysis of all patients, 5-year overall survival (OS) and disease-free survival (DFS) rate were 94.9 and 79.2%, respectively. 19 patients developed recurrent disease at a median of 26.1 months from surgery and most common recurrence site was liver (63.2%). In multivariate analysis, mitotic count was the statistically significant prognostic factors of DFS. Our 20 cases of duodenal GIST in 1st or 4th portion were completely resected by limited resection(LR), regardless of tumor size. 98 patients with GISTs in 2nd or 3rd portion of duodenum underwent LR (n = 53) or pancreaticoduodenectomy (PD) (n = 45). Patients in the LR group had a smaller median tumor size (4.0 vs 5.3 cm, p = 0.026), more antimesenteric-sided location (41 vs 7cases, p < 0.001), less late complications (1 vs 7 cases, p = 0.014) and no postoperative newly developed diabetes mellitus (0 vs 4 cases, p = 0.027) than those in the PD group. When 53 patients in LR group further divided into minimal invasive LR (MILR) (n = 12) and open-LR (n = 41), MILR group had shorter operation time (155.0 vs 218.8 minutes, p = 0.013) and postoperative hospital stay (12.0 vs 19.4 days, p = 0.036). Conclusions: Patients with duodenal GIST who underwent complete surgical resection have favorable survival outcomes. Predictor of disease recurrence at multivariate analysis was mitotic count. LR is feasible and effective surgical treatment for the patients with small-sized, and anti-mesenteric sided duodenal GIST in terms of long-term oncologic outcomes and quality of life. MILR has better perioperative outcomes than open LR. Therefore, we should consider MILR as optimal surgical treatment for the selected patients with duodenal GIST.

Extra-gastrointestinal stromal tumor of the pancreas: report of a case

Gastrointestinal tumors (GISTs) of the pancreas are extremely rare with limited individual case reports and small number of case series. Herein, we report a case of pancreatic extragastrointestinal stromal tumor (EGIST) along with literature review. A 64-year-old female patient was referred to us for treatment of an abdominal mass detected by ultrasonographic examination. The tumor was located in the periamullary region. Under a preoperative diagnosis of a duodenal GIST, we performed a pylorus preserving pancreatoduodenectomy for this lesion. Laboratory examination results were within normal ranges. On pathologic gross examination, the tumor measured at 7 cm in its greatest dimension almost entirely involved the pancreatic head. Its cut surface was rubbery and white. It was surrounded by a thin pseudocapsule and well demarcated. Histopathological examination of the specimen showed a cellular lesion with compressed pancreatic tissue at peripheral. Mitotic count was 5 per 50 high-power fields. Immunohistochemically, neoplastic cells were positive for antibodies against C-KIT (CD117), CD 34, and vimentin. However, smooth-muscle actin reactions with antibodies against S-100 or desmin were negative. Based on above findings, the tumor was finally diagnosed as GISTs originating from the pancreas. The patient has been followed up postoperatively for 72 months. There is no evidence of recurrence. Here we report this case of pancreatic EGIST presenting as a solid neoplasm along with literature review of cases previously described. Our review on pancreatic EGISTs is limited and insufficient to make a conclusion regarding its clinical features. Those manifested large masses tended to have an aggressive biological and clinical behavior. Thus, pancreatic EGISTs need to be carefully differentiated. Adequate surgical intervention is necessary for pancreatic EGISTs.

Local resection for duodenal gastrointestinal stromal tumors

BackgroundDuodenal gastrointestinal tumors (GIST) present infrequently, and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of lymphatic and submucosal spread and anatomic location near the bile duct and pancreas, the optimal approach for resection is unknown. Options include local resection (LR), segmental resection, and pancreaticoduodenectomy (PD). MethodsAll cases of gastrointestinal stromal tumors originating from the duodenum from 2000 to 2015 were identified from administrative databases. Clinical and pathologic information was abstracted from the medical record and compared between patients who received LR vs PD. The chi-square with Fisher's exact test was used to detect differences between groups. ResultsFifteen patients met the inclusion criteria, of which 7 had an LR and 8 had a PD. The second portion of the duodenum was the most common origin of GIST in the PD group, whereas the third portion was most common in the LR group. Patients who underwent LR tended to be younger, but there was no difference in tumor size, mitotic rate, margin positivity, readmission rate, or recurrence. PD was associated with more complications, higher blood loss, and longer length of stay. ConclusionsLocal resection is a reasonable option for resection of duodenal GIST and should be routinely considered if technically feasible.

Gastrointestinal stromal tumor involving the second and third portion of the duodenum: Treatment by partial duodenectomy and Roux‐en‐Y duodenojejunostomy

The optimal surgical procedure for duodenal gastrointestinal tumors (GIST) remains undefined because while surgical resection clearly confers survival advantage, there is little submucosal spread in GIST and lymphatic involvement is rare. Various surgical procedures for duodenal GIST, pancreatoduodenectomy, pancreas-sparing duodenectomy, segmental duodenectomy, or local resection, have been described depending on the size and exact site of the lesion. In this report, we describe two cases of GIST involving the second and third portion of the duodenum successfully treated by partial duodenectomy with Roux-en-Y duodenojejunostomy. This surgical technique is ideal when GIST does not involve the ampulla as it avoids a pancreatoduodenectomy and has not been previously described for the management of this malignancy.