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Wu L, Liu M, Lin X, Wang C, Yang Y, Fang H, Huang H, Lin R, Lu F. Feasibility and efficacy of minimally invasive limited resection for primary duodenal gastrointestinal stromal tumors: a retrospective cohort study. BMC Surg 2024; 24:126. [PMID: 38678296 PMCID: PMC11055357 DOI: 10.1186/s12893-024-02417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST. METHODS The clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD). RESULTS A total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group. All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups. CONCLUSIONS Minimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.
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Affiliation(s)
- Longhang Wu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Miao Liu
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, Fujian, China
- Department of Gastrointestinal Endoscopy Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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Zhu MP, Ding QL, Xu JX, Jiang CY, Wang J, Wang C, Yu RS. Building contrast-enhanced CT-based models for preoperatively predicting malignant potential and Ki67 expression of small intestine gastrointestinal stromal tumors (GISTs). ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3161-3173. [PMID: 33765174 DOI: 10.1007/s00261-021-03040-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess contrast-enhanced computed tomography (CE-CT) features for predicting malignant potential and Ki67 in small intestinal gastrointestinal stromal tumors (GISTs) and the correlation between them. METHODS We retrospectively analyzed the pathological and imaging data for 123 patients (55 male/68 female, mean age: 57.2 years) with a histopathological diagnosis of small intestine GISTs who received CE-CT followed by curative surgery from May 2009 to August 2019. According to postoperatively pathological and immunohistochemical results, patients were categorized by malignant potential and the Ki67 index, respectively. CT features were analyzed to be associated with malignant potential or the Ki67 index using univariate analysis, logistic regression and receiver operating curve analysis. Then, we explored the correlation between the Ki67 index and malignant potential by using the Spearman rank correlation. RESULTS Based on univariate and multivariate analysis, a predictive model of malignant potential of small intestine GISTs, consisting of tumor size (p < 0.001) and presence of necrosis (p = 0.033), was developed with the area under the receiver operating curve (AUC) of 0.965 (95% CI, 0.915-0.990; p < 0.001), with 91.53% sensitivity, 96.87% specificity, 96.43% PPV, 92.54% NPV, 94.31% diagnostic accuracy. For high Ki67 expression, a model made up of tumor size (p = 0.051), presence of ulceration (p = 0.054) and metastasis (p = 0.001) may be the best predictive combination with an AUC of 0.785 (95% CI, 0.702-0.854; p < 0.001), 63.33% sensitivity, 76.34% specificity, 46.34% PPV, 86.59% NPV, 73.17% diagnostic accuracy. Ki67 index showed a moderate positive correlation with mitotic count (r = 0.578, p < 0.001), a weak positive correlation with tumor size (r = 0.339, p < 0.001) and with risk stratification (r = 0.364, p < 0.001). CONCLUSION Features on CE-CT could preoperatively predict malignant potential and high Ki67 expression of small intestine GISTs, and Ki67 index may be a promising prognostic factor in predicting the prognosis of small intestine GISTs, independent of the risk stratification system.
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Affiliation(s)
- Miao-Ping Zhu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
- Department of Radiology, Hangzhou Women's Hospital, Hangzhou, China
| | - Qiao-Ling Ding
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chun-Yan Jiang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
- Department of Radiology, People's Hospital of Songyang County, Lishui, China
| | - Jing Wang
- Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Chao Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
| | - Ri-Sheng Yu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
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Complete wedge resection for duodenal gastrointestinal stromal tumour: A case series of three patients. Int J Surg Case Rep 2021; 90:106674. [PMID: 34902701 PMCID: PMC8666637 DOI: 10.1016/j.ijscr.2021.106674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/04/2021] [Accepted: 12/04/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Duodenal gastrointestinal stromal tumours (GIST) are rare. Therefore, difficulties are experienced when selecting the appropriate surgical procedure in patients with duodenal GISTs. This report presents the cases of three patients with duodenal GISTs who underwent wedge resection. This report would help surgeons identify clinical features and surgical procedures in patients with duodenal GISTs. PRESENTATION OF CASE Three patients were diagnosed with duodenal submucosal tumours. The first patient presented with melena, the second with postoperative anaemia, and the third with an incidental finding of a large abdominal tumour after presenting with ischaemic colitis. All tumours arose in the 2nd portion of the duodenum and measured 3.5, 3, and 9.2 cm, respectively. Wedge resection of the duodenum was performed in all patients. In patients one and two, simple closure of duodenal wall was performed after wedge resection. In patient three, side-to-side anastomosis with the jejunum was performed because a large area of the wall was removed using the wedge resection technique. Pancreatoduodenectomy was avoided in all patients. Recurrence was not noted in any patient. DISCUSSION Since GISTs are not generally associated with lymph node metastasis, local resection with negative margins is sufficient to surgically manage patients with GISTs. CONCLUSION Our results indicated the effectiveness of performing wedge resection for duodenal GISTs not in close proximity to the ampulla of Vater. Moreover, less invasive procedures should be adopted in patients with duodenal GISTs.
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Lim KT. Current surgical management of duodenal gastrointestinal stromal tumors. World J Gastrointest Surg 2021; 13:1166-1179. [DOI: https:/doi.org/10.4240/wjgs.v13.i10.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
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Lim KT. Current surgical management of duodenal gastrointestinal stromal tumors. World J Gastrointest Surg 2021; 13:1166-1179. [PMID: 34754385 PMCID: PMC8554720 DOI: 10.4240/wjgs.v13.i10.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Duodenal gastrointestinal stromal tumors (D-GISTs) are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors. They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater, pancreas, mesenteric blood vessels, biliary and pancreatic ducts. The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved. The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location, size and involvement of surrounding structures such as wedge resection with primary closure, segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy. Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands. The minimally invasive techniques including robotic-assisted approach will likely increase in the future. D-GISTs have a prognosis comparable to gastric and other small bowel GISTs. However, the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs. The use of limited resection when condition allows is recommended due to lower surgical morbidity, less postoperative complications and better oncologic outcomes.
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Affiliation(s)
- Kheng Tian Lim
- Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
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Vassos N, Perrakis A, Hohenberger W, Croner RS. Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST). J Clin Med 2021; 10:jcm10194459. [PMID: 34640476 PMCID: PMC8509470 DOI: 10.3390/jcm10194459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. METHODS We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12-140). RESULTS A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42-77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5-13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. CONCLUSION The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.
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Affiliation(s)
- Nikolaos Vassos
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-621-383-3921; Fax: +49-621-383-1479
| | - Aristotelis Perrakis
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany; (A.P.); (R.S.C.)
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Wu YZ, Li Y, Wu M, Zheng XH, Tian YT, Xie YB. Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors. World J Gastrointest Oncol 2021; 13:959-969. [PMID: 34457198 PMCID: PMC8371521 DOI: 10.4251/wjgo.v13.i8.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumor (DGIST) is a rare tumor with a specific anatomic site and biological characteristics. As the incidence of lymph node metastasis is very low, the main treatment method is surgery. Two main surgical techniques (local resection and Whipple) are performed in patients with DGISTs. The critical question is which surgical technique to choose.
AIM To identify factors influencing the choice of surgery for DGISTs.
METHODS The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed. We used the Student’s t-test or Mann-Whitney U-test and the χ2 test or Fisher’s exact test to determine the differences between the two groups of patients. Furthermore, we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery. The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors.
RESULTS Overall, 86 patients were analyzed, including 43 men (50%) and 43 women (50%). We divided the patients into two groups based on surgical technique (local resection or Whipple surgery). There were no differences in the age, mitotic figures, and complications between the two groups; however, the tumor size, tumor location, risk grade, postoperative hospital stay, and abdominal drainage time were significantly different. Based on univariate logistic analysis, the Whipple procedure was chosen if the tumor size was ≥ 5.0 cm, the tumor was located in the descending part of the duodenum, or the risk grade was medium or high. In our research, the five-year overall survival rate of patients was more than 90%. We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases.
CONCLUSION The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum, tumor size was ≥ 5.0 cm, or the tumor risk grade was medium or high.
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Affiliation(s)
- Yun-Zi Wu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ming Wu
- Department of Gastric Surgery, Yun Cheng Center Hospital, Yucheng 043300, Shanxi Province, China
| | - Xiao-Hao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yi-Bin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Wu YZ, Li Y, Wu M, Zheng XH, Tian YT, Xie YB. Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i8.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pyuza JJ, Shao ER, Bosco K, Lodhia J, Mremi A. An incidental finding of duodenal GIST in a patient with penetrating abdominal trauma: A case report. Int J Surg Case Rep 2021; 85:106263. [PMID: 34388898 PMCID: PMC8350535 DOI: 10.1016/j.ijscr.2021.106263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Duodenal Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the digestive tract. The tumors are derived from interstitial cells of Cajal and usually they present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic even when they have reached considerable size. CASE PRESENTATION We report a case of a 40-year-old male presented to our emergency department after sustaining a stab wound on the abdomen. Abdominal imaging tests weren't done; instead an emergency laparotomy was undertaken upfront in an attempt to catch up with a "golden hour". Intra-operatively, an incidental solid mass measuring 4 × 5 cm was noted on the third/fourth portion of the interior duodenal flexure. Histopathologically, the lesion demonstrated spindled shaped cells which were immunopositive for positive CD117. The patient fared well postoperatively and during subsequent follow up visits. CLINICAL DISCUSSION High-risk GISTs have malignant potential. In some cases, GIST is diagnosed as incidentally finding, mostly during surgical procedure, upper endoscopy or radiological studies related to GI tract. Surgical resection is recommended curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. CONCLUSION Even considerably large duodenal GISTs can be asymptomatic, thus incidentally found during an abdomino-pelvic imaging tests. Histopathological evaluation of the operative specimen plays a key role in assessing the need of adjuvant therapy, with a significant impact on the patients' survival.
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Affiliation(s)
- Jeremia J Pyuza
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O.BOX 3010, Moshi, Tanzania
| | - Elichilia R Shao
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania; Department of Internal Medicine, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Kenan Bosco
- Department of Internal Medicine, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Jay Lodhia
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Center, P.O.BOX 3010, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O.BOX 3010, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O, BOX 2240, Moshi, Tanzania.
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Zhou ZP, Tan XL, Zhao ZM, Gao YX, Song YY, Jia YZ, Li CG. Robotic resection of duodenal gastrointestinal stromal tumour: Preliminary experience from a single centre. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Zhou ZP, Tan XL, Zhao ZM, Gao YX, Song YY, Jia YZ, Li CG. Robotic resection of duodenal gastrointestinal stromal tumour: Preliminary experience from a single centre. World J Gastrointest Oncol 2021; 13:706-715. [PMID: 34322199 PMCID: PMC8299937 DOI: 10.4251/wjgo.v13.i7.706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors (DGISTs) is accumulating, but there is no consensus on the choice of surgical method.
AIM To summarize the technique and feasibility of robotic resection of DGISTs.
METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1, 2010 and May 1, 2020 were retrospectively analyzed. The patients were divided into the open surgery group and the robotic surgery group. Pancreatoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.
RESULTS Of the 28 patients included, 19 were male and 9 were female aged 51.3 ± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (P > 0.05). OT and EBL in the robotic group were significantly different to those in the open surgery group (P < 0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (P > 0.05).
CONCLUSION Robotic resection is safe and feasible for patients with DGISTs, and its therapeutic effect is equivalent to open surgery.
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Affiliation(s)
- Zhi-Peng Zhou
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiang-Long Tan
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi-Ming Zhao
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuan-Xing Gao
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Yao Song
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Ze Jia
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Cheng-Gang Li
- Department of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
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Dubois C, Nuytens F, Behal H, Gronnier C, Manceau G, Warlaumont M, Duhamel A, Denost Q, Honoré C, Facy O, Tuech JJ, Tiberio G, Brigand C, Bail JP, Salame E, Meunier B, Lefevre JH, Mathonnet M, Idrissi MS, Renaud F, Piessen G. Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study. Ann Surg Oncol 2021; 28:6294-6306. [PMID: 33839975 DOI: 10.1245/s10434-021-09862-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. OBJECTIVES The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). METHODS In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. RESULTS Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. CONCLUSIONS For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
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Affiliation(s)
- Clément Dubois
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France
| | - Frederiek Nuytens
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.
| | - Hélène Behal
- University Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Caroline Gronnier
- Department of Digestive Surgery, Haut Lévêque University Hospital, Bordeaux, France
| | - Gilles Manceau
- Department of Digestive Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Maxime Warlaumont
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France
| | - Alain Duhamel
- University Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Quentin Denost
- Department of Digestive Surgery, Haut Lévêque University Hospital, Bordeaux, France
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Olivier Facy
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Guido Tiberio
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cécile Brigand
- Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France
| | - Jean-Pierre Bail
- Department of Digestive Surgery, Brest University Hospital, Brest, France
| | - Ephrem Salame
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - Bernard Meunier
- Department of Digestive Surgery, Pontchailloux University Hospital, Rennes, France
| | - Jérémie H Lefevre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Muriel Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | | | - Florence Renaud
- Department of Pathology, Lille University Hospital, Lille, France.,University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.,University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
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Santos AJ, Tojal A, Duarte L, Marques C, Pinheiro LF, Casimiro C. Asymptomatic large duodenal GIST - An incidental finding in abdominopelvic ultrasonography: A case report. Int J Surg Case Rep 2020; 76:301-304. [PMID: 33068854 PMCID: PMC7569183 DOI: 10.1016/j.ijscr.2020.09.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022] Open
Abstract
Duodenal GISTs are rare tumors of the digestive tract and although frequently symptomatic, they can also be diagnosed incidentally. The management of GISTs should be conducted by a multidisciplinary team. Surgery is the only potentially curative treatment for non-metastatic GISTs and the gold standard for local disease. The recurrence of GISTs appears to have a stronger connection to the tumor biology rather than the kind of surgery performed. High-risk GISTs have a formal indication for adjuvant therapy with a tyrosine kinase inhibitor.
Introduction Duodenal GISTs are rare mesenchymal tumors of the digestive tract. They usually present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic. High-risk GISTs have malignant potential. Surgical resection is the only curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. Case description We herein report the case of a 75-year-old male, referred to our general surgery outpatient clinic, with an asymptomatic duodenal mass incidentally diagnosed during an abdominopelvic ultrasonography. Abdominal CT suggested GIST. Since no other lesions were found, a segmental duodenectomy was performed and the patient recovery was uneventful. Histologic exam confirmed the presence of a high-risk GIST, therefore adjuvant therapy with imatinib was initiated. Discussion Duodenal involvement by GISTs is rare, even more in its third/fourth portions. The widespread clinical use of radiological exams such as ultrasonography may lead to the diagnosis of asymptomatic masses. Surgical treatment is the gold-standard giving the malignant potential of these neoplasms. There are risk stratification scores that may be used to assess the need for adjuvant therapy. Conclusion Even large GISTs can by asymptomatic. Giving their malignant potential, early diagnosis and treatment are crucial. The histologic findings and genetic profile have an impact on the patient’s survival.
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Affiliation(s)
- Andreia J Santos
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal.
| | - André Tojal
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal
| | - Liliana Duarte
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal; Esophagogastric Surgery Unit, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal; Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã, Portugal
| | - Conceição Marques
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal; Esophagogastric Surgery Unit, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal
| | - Luís F Pinheiro
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal; Esophagogastric Surgery Unit, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal
| | - Carlos Casimiro
- General Surgery Department, Tondela-Viseu Hospital Centre, Av. Rei D. Duarte, Viseu, Portugal
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Duodenal GIST: Surgical treatment based on the location. A single center experience with review of the literature. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.760582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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15
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Lu C, Jin W, Mou Y, Shao H, Wu X, Li S, Xu B, Wang Y, Zhu Q, Xia T, Zhou Y. Optimal Laparoscopic Management and Oncological Outcomes of Gastrointestinal Stromal Tumors in Duodenum: Pancreaticoduodenectomy or Pancreas-Sparing Duodenectomy? Cancer Manag Res 2020; 12:4725-4734. [PMID: 32606963 PMCID: PMC7310982 DOI: 10.2147/cmar.s254972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) of the duodenum are rarely reported and optimal minimally invasive management has not been well proposed. Pancreaticoduodenectomy and different types of pancreas-sparing duodenectomy can be chosen; however, which to choose and its corresponding clinical outcomes and oncological concerns remain controversial. Patients and Methods Patients diagnosed with GIST of duodenum underwent laparoscopic pancreaticoduodenectomy (L-PD) or pancreas-sparing duodenectomy (L-PSD) in Zhejiang Provincial People's Hospital were enrolled. All prospectively maintained data were analyzed retrospectively. Patients were grouped into the L-PD group or the L-PSD group, and the clinical outcomes and oncological outcomes were analyzed. Results Between June 2013 and March 2019, a total of 22 patients (11 males/11 females) underwent surgical management, including 13 L-PDs and 9 L-PSDs. The average age was 58.2±9.5 year-old (median 60.5 year-old). The most common presentations were GI bleeding (54.5%) and abdominal discomfort (27.2%), and the dominant lesion located in the second portion of duodenum (59.1%). Compared with L-PD group, L-PSD group showed much shorter operation time (364.2±58.7min vs. 230.0±12.3min, P<0.001), less blood loss (176.9±85.7mL vs. 61.1±18.2min, P<0.001), faster recovery to off-bed (2.6±1.3d vs. 1.1±0.3d, P=0.003), anus flatus (4.5±1.0d vs. 2.4±0.5d, P<0.001) and liquid intake (4.9±1.3d vs. 2.3±0.5d, P<0.001). Lymph node retrieval was much less in L-PSD, but no lymph node metastasis was observed in any patients. L-PSD had much Lower morbidity of both minor (Grade I/II) and major (III/IV/V) complications than that of L-PD (11.1% vs. 61.6%, P=0.02), resulting in shorter hospital stays (10.9±3.8d vs. 20.6±11.1d, P=0.021) and less total cost (76,972.4±11,614.8yuan vs 125,628.7±46,356.8yuan, P=0.006). The median follow-up was 42 months (range from 12 to 82months) without loss. Only 1 L-PD patient suffered hepatic metastasis 36months after surgery, and given sunitinib to stabilize the disease, none of the rest observed recurrence or metastasis. Conclusion For GIST located opposite the major papilla, L-PSD showed comparable safety and oncological benefits when compared to L-PD, with shorter operation time, less blood loss and much faster recovery time, resulting in much less total cost. L-PSD should be applied in selected patients with experienced hands.
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Affiliation(s)
- Chao Lu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.,School of Medicine, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Weiwei Jin
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hongliang Shao
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Xiaosan Wu
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Shaodong Li
- School of Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Biwu Xu
- School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People's Republic of China
| | - Yuanyu Wang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qicong Zhu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Tao Xia
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yucheng Zhou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, People's Republic of China.,Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.,School of Medicine, Soochow University, Suzhou, Jiangsu Province, People's Republic of China
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Marano A, Allisiardi F, Perino E, Pellegrino L, Geretto P, Borghi F. Robotic Treatment for Large Duodenal Gastrointestinal Stromal Tumor. Ann Surg Oncol 2019; 27:1101-1102. [PMID: 31696397 DOI: 10.1245/s10434-019-08041-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Duodenal gastrointestinal stromal tumors (D-GISTs) represent a rare entity.1 Surgery is the primary treatment choice for localized or potentially resectable D-GISTs. The main principle is the complete excision of the lesion with microscopically negative margins, without performing lymph node dissection.2 Nevertheless, the best surgical choice is still controversial since the strategy depends not only on the tumor size but also on its anatomic location.3,4 As a result, surgical management ranges from a major resection such as pancreaticoduodenectomy to more conservative procedures.5-8 This video presents a duodenal sparing robotic resection of a large GIST of the second-third duodenal portion. METHODS A 49-year-old healthy female complained episodes of melena. Endoscopy with endoscopic ultrasound identified a 6-cm lesion of the second-third portion of the duodenum with recent bleeding, arising from muscolaris propria. A computed tomography scan confirmed a large mass suspected to be a GIST without metastases or involvement of the ampulla of Vater. On the basis of these findings, after a multidisciplinary consultation, she was offered robotic surgery with a radical intent. RESULTS A duodenal-sparing da Vinci®Si™ resection with robot-sewn primary duodenal closure was performed. After an uneventful postoperative course, the patient was discharged on post-operative day 7. Final pathology revealed a high-grade risk D-GIST with free margins: adjuvant Imatinib was recommended.9 At 4 years follow-up, no recurrence has been detected. CONCLUSIONS A robotic approach might be considered in cases of large D-GISTs amenable to a conservative R0 surgery. This system provides several technical advantages that facilitate otherwise complex resection and reconstruction.10.
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Affiliation(s)
- Alessandra Marano
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Fabrizio Allisiardi
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Enrico Perino
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Paolo Geretto
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Felice Borghi
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy.
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Shen Z, Chen P, Du N, Khadaroo PA, Mao D, Gu L. Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis. BMC Surg 2019; 19:121. [PMID: 31455328 PMCID: PMC6712818 DOI: 10.1186/s12893-019-0587-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background By comparing the long-term prognostic outcomes after pancreaticoduodenectomy (PD) and limited resection (LR), this study aimed to investigate the optimal surgical modality for duodenal gastrointestinal stromal tumors (GISTs). Methods Two authors independently searched PubMed, Web of Science, Embase, and the Cochrane Library for published articles comparing the long-term prognostic and clinicopathological factors of duodenal GIST patients undergoing PD versus LR. Relevant information was extracted and analyzed. Results After screening, 10 items comprising 623 cases were eventually included. This meta-analysis explicitly indicated that PD treatment was associated with worse long-term prognosis (hazard ratio = 1.93; 95% confidence interval [CI], 1.39–2.69; p < 0.001; I2 = 0) and more complications (odds ratio [OR] = 2.90; 95% CI, 1.90–4.42; p < 0.001; I2 = 10%) than LR treatment. Nevertheless, for duodenal GISTs, PD was related to the following clinicopathological features: invasion of the second part of the duodenum (OR = 3.39; 95% CI, 1.69–6.79; p < 0.001; I2 = 50%), high-degree tumor mitosis (> 5/50 high-power fields; OR = 2.24; 95% CI, 1.42–3.52; p < 0.001; I2 = 0), and high-risk classification (OR = 3.17; 95% CI; 2.13–4.71; p < 0.001; I2 = 0). Conclusions Since PD is associated with worse long-term prognosis and more complications, its safety and efficacy should be ascertained. Our findings recommend the use of LR to obtain negative incision margins when conditions permit it. Electronic supplementary material The online version of this article (10.1186/s12893-019-0587-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zefeng Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, 315010, Zhejiang, China
| | - Nannan Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Parishit A Khadaroo
- Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, 315010, Zhejiang, China.
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Taskovska M, Omejc M, Grosek J. Small gastrointestinal stromal tumour of the duodenum causing a life-threatening bleeding - A case report and review of the literature. Int J Surg Case Rep 2019; 57:160-162. [PMID: 30959366 PMCID: PMC6454093 DOI: 10.1016/j.ijscr.2019.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022] Open
Abstract
Gastrointestinal stromal tumours could be source of massive (life-threatening bleeding). If massive bleeding is present in patient with gastrointestinal stromal tumour, surgical treatment is indicated, without further diagnostics. Depending on location and size of GIST, extend of surgical treatment varies. En bloc resection is required, role of lymphadenectomy is not clear. In setting when patient is stable, diagnostic evaluation is performed first, to access size, location of tumour and plan best surgical approach. Treatment of gastrointestinal stromal tumours should be multidisciplinary.
Introduction Duodenal gastrointestinal stromal tumors (DGISTs) are mesenchymal tumors. Main presenting symptoms are gastrointestinal bleeding and non-specific abdominal pain. Surgical treatment is golden standard for treatment of DGISTs. Tumour location and size determine the surgical strategy. Recurrence rate depends on tumour location and completeness on removal. Presentation of case 75 years old male fell ill with hematemesis, hemohesia and dizziness. Oesophagogastroduodenoscopy (EGD) did not reveal the source of bleeding. Upon admission, a second EGD was performed due to loss of consciousness and anaemia, which revealed only approximate source of bleeding in the third portion of the duodenum. The exact bleeding spot could not be reached and bleeding could not be controlled endoscopically. Patient was transferred to the operating room for an emergency explorative laparotomy. After extensive mobilisation of the duodenum a 2 × 2 cm intraluminal tumour with central bleeding ulceration was found in D3. The diseased part of the duodenum was excised and the duodenotomy was closed with interrupted sutures. Final pathohistological report confirmed gastrointestinal stromal tumour, pT1. Postoperative period was uneventful. Discussion Gastrointestinal stromal tumours are most common in males aged 60–65 years. Surgical treatment is a golden standard. Surgical approach depends upon tumor location and size. In case of major bleeding surgical procedure is lifesaving and diagnostics for staging purposes are omitted. Conclusion Gastrointestinal stromal tumors are a potential source of life-threatening bleeding. In such cases an emergency operation is often indicated with aim to remove the tumour en bloc and achieve hemostasis as soon as possible.
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Affiliation(s)
- Milena Taskovska
- Department of Urology, University Medical Centre Ljubljana, Zaloška c. 7, 1000 Ljubljana, Slovenia.
| | - Mirko Omejc
- Department of Abdominal surgery, University Medical Centre Ljubljana, Zaloška c. 7, 1000 Ljubljana, Slovenia.
| | - Jan Grosek
- Department of Abdominal surgery, University Medical Centre Ljubljana, Zaloška c. 7, 1000 Ljubljana, Slovenia.
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