Duodenal GIST: Surgical treatment based on the location. A single center experience with review of the literature
Keywords:Gastrointestinal stromal tumor, Duodenum, Surgery procedures
Aim: Gastrointestinal stromal tumors (GIST) are the most common digestive tract mesenchymal neoplasms, but only 1 to 5% of GISTs occur in the duodenum. Consequently, clinical manifestations, management and surgical treatment and their results remain poorly defined. The aim of this study is to expose the surgical experience in our institution, analyze surgical procedures according to the location of the tumor in the duodenum, and review the surgical management of GISTs in this anatomically complex region.
Methods: Patients with duodenal GISTs who were surgically treated with curative intention in our center during the last 5 years (January 2014 - December 2019) were included in this retrospective cohort study. Demographic data, clinical presentation, GIST location, diagnostic evaluation, oncologic treatment, surgical procedure, mortality and morbidity, pathological and morphological GIST characteristics, pathological risk category, follow up and survival were noted.
Results: Five patients diagnosed with duodenal GIST were operated in our center during the last 5 years. Four surgeries were performed with intent to cure and negative margins of resection. Only one was performed by laparoscopic approach. Limited resection R0 was done in all cases. None of the patients received neoadjuvant treatment before surgery. All patients were women with a mean age of 63 years (52-70 years). Clinical manifestations consisted of abdominal pain and upper gastrointestinal bleeding. One of the cases was incidentally diagnosed. There was no postoperative mortality. Mean length of stay was of 8 days (4-26 days). The median follow-up time was 33 months (6 months - 8 years). During the follow up, 2 patients passed away due non-GIST related causes, and one patient was operated for resectable peritoneum metastasis 29 months after the initial surgery.
Conclusion: Tumor biology is more important than the surgical procedure for oncologic results of duodenal GIST. GIST located in duodenum with surgical indication is a challenge for the surgeon due to the complex duodenum anatomy.
Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force Report: Update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010;8(2):S-1-S-41. doi: 10.6004/jnccn.2010.0116
Chok AY, Koh YX, Ow MYL, Allen JC, Goh BKP. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumours. Ann Surg Oncol. 2014;21(11):3429-38. doi: 10.1245/s10434-014-3788-1
Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, et al. Gastrointestinal stromal tumours, intramural leiomyomas, and leiomyosarcomas in the duodenum: A clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol. 2003;27(5):625-41. doi: 10.1097/00000478-200305000-00006
Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, et al. Management and outcome of gastrointestinal stromal tumours of the duodenum. J Gastrointest Surg. 2010;14(5):880-3. doi: 10.1007/s11605-010-1170-6
Marano L, Boccardi V, Marrelli D, Roviello F. Duodenal gastrointestinal stromal tumour: From clinicopathological features to surgical outcomes. Eur J Surg Oncol. 2015;41(7):814-22. doi: 10.1016/j.ejso.2015.04.004
Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Eighth edition. Chichester, West Sussex, UK ; Hoboken, NJ: John Wiley & Sons, Inc; 2017.
Casali PG, Abecassis N, Bauer S, Biagini R, Bielack S, Bonvalot S, et al. Gastrointestinal stromal tumours: ESMO–EURACAN Clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:68-78. doi: 10.1093/annonc/mdy095
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae
Beltrán MA. Current management of duodenal gastrointestinal stromal tumours. Clin Oncol. 2016;1:10.
Liu Z, Zheng G, Liu J, Liu S, Xu G, Wang Q, et al. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumours: a series of 300 patients. BMC Cancer. 2018;18(1):563. doi: 10.1186/s12885-018-4485-4
Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D’Andrea V, et al. Surgical treatment of gastrointestinal stromal tumours of the duodenum: a literature review. Transl Gastroenterol Hepatol. 2018;3:71-71. doi:.10.21037/tgh.2018.09.04
Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumour. Human Pathology. 2008;39(10):1411-9. doi.org/10.1016/j.humpath.2008.06.025
Lee SJ, Song KB, Lee Y-J, Kim SC, Hwang DW, Lee JH, et al. Clinicopathologic characteristics and optimal surgical treatment of duodenal gastrointestinal stromal tumour. J Gastrointest Surg. 2019;23(2):270-9. doi: 10.1007/s11605-018-3928-1
Soft tisue sarcoma. NCCN clinic practice guidelines [Internet] Versión 6.2019. http:// www.nccn.org
Fernández JÁ, Sánchez-Cánovas ME, Parrilla P. Controversias en el tratamiento quirúrgico de los tumores del estroma gastrointestinal (GIST) primarios. Cir Esp. 2010;88(2):69-80. doi: 10.1016/j.ciresp.2010.01.007
Tien Y-W, Lee C-Y, Huang C-C, Hu R-H, Lee P-H. Surgery for gastrointestinal stromal tumours of the duodenum. Ann Surg Oncol. 2010;17(1):109-14. doi: 10.1245/s10434-009-0761-5
Zhou Y, Wang X, Si X, Wang S, Cai Z. Surgery for duodenal gastrointestinal stromal tumour: A systematic review and meta-analysis of pancreaticoduodenectomy versus local resection. Asian J Surg. 2020;43(1):1-8. doi.org/10.1016/j.asjsur.2019.02.006
Mennigen R, Wolters HH, Schulte B, Pelster FW. Segmental resection of the duodenum for gastrointestinal stromal tumour (GIST). World J Surg Oncol. 2008;6:105 doi: 10.1186/1477-7819-6-105
Hashimoto D, Inoue R, Beppu T. Limited resection of the duodenum for nonampullary duodenal tumours, with review of the literature. Am Surg. 2016;82(11):8.
Kamath AS, Sarr MG, Nagorney DM, Que FG, Farnell MB, Kendrick ML, et al. Gastrointestinal stromal tumour of the duodenum: single institution experience. HPB. 2012;14(11):772-6. doi: 10.1111/j.1477-2574.2012.00535.x
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