Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Jan;24(1):202-210.
doi: 10.1245/s10434-016-5565-9. Epub 2016 Sep 13.

Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor

Ser Yee Lee  1   2   3 , Brian K P Goh  2   3 , Eran Sadot  1 , Rahul Rajeev  1 , Vinod P Balachandran  1 , Mithat Gönen  4 , T Peter Kingham  1 , Peter J Allen  1 , Michael I D'Angelica  1 , William R Jarnagin  1 , Daniel Coit  1 , Wai Keong Wong  3   5 , Hock Soo Ong  3   5 , Alexander Y F Chung  2   3 , Ronald P DeMatteo  6
Affiliations
Multicenter Study

Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor

Ser Yee Lee et al. Ann Surg Oncol. 2017 Jan.

Abstract

Background: The surgical management of duodenal gastrointestinal stromal tumors (DGIST) is poorly characterized. Limited resection may be technically feasible and oncologically safe, but anatomic considerations may compromise the resection margins due to the proximity of critical structures, thereby necessitating more extensive resections such as pancreaticoduodenectomy.

Methods: Patients undergoing surgery for DGIST at two institutions from 1994 to 2014 were identified. Clinicopathologic and survival data were analyzed to compare outcomes in patients treated with limited or radical resection.

Results: Sixty patients underwent surgery for DGIST. Pancreaticoduodenectomy was performed in 38 % while the rest underwent limited resections. The most common type of limited resection was wedge resection and primary closure (49 %) followed by segmental resection with an end-to-end or side-to-side duodenojejunostomy (27 %). The pancreaticoduodenectomy group tended to have larger tumors with the majority located in D2/3 (87 %) and at the mesenteric border (91 %). The pancreaticoduodenectomy group also had significantly greater intraoperative blood loss, longer operative time, longer hospital stay, and higher 90-day morbidity and readmission rates. The 5-year relapse-free survival, recurrence-free survival, and overall survival for the pancreaticoduodenectomy versus limited resection were 81 versus 56 % (p = 0.05), 64 versus 53 % (p = 0.5), and 76 versus 72 % (p = 0.6), respectively. A surgical algorithm based on the location and size of the tumor is proposed.

Conclusions: Limited resection of DGIST is safe, but may be associated with lower 5-year relapse-free survival. Pancreaticoduodenectomy is recommended for selected patients with DGIST when an R0 resection cannot be performed without removing the ampulla or part of the pancreas.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Location of duodenal GISTs: Resection and reconstruction options
A: Location of the duodenal GISTs classified according to the duodenal site and mesenteric vs. anti-mesenteric border. D1: First part of the duodenal; D2: Second part of the duodenum; D1/2: Junction between D1 and D2; D3: Third part of the duodenum; D2/3: Junction between D2 and D3; D4: Fourth part of the duodenum; D3/4: Junction between D3 and D4; D4/jejunum: Junction between D4 and the jejunum. B: Various techniques and options of resection and reconstruction of duodenal GISTs according to location and size. i: Distal gastrectomy for D1 GIST followed by either a Roux-en-Y or a Loop reconstruction. ii: Wedge resection of D2 GIST followed by primary closure if amenable, if not - with a side to side Roux-en-Y duodenojejunostomy. iii: Segmental resection of a D2 or D2/3 GIST with an end-to-end or side-to-side duodenojejunostomy. iv: Resection of a mesenteric based GIST via pancreaticoduodenectomy with either a pancreaticojejunostomy or a pancreaticogastrostomy loop reconstruction.
Figure 2
Figure 2. Outcomes after surgery
A. Relapse-free survival. B. Recurrence-free survival. C. Overall survival. *1 patient in the limited resection group was excluded from the surival analysis due to missing follow-up data.
Figure 3
Figure 3. Algorithm for surgical management of duodenal GISTs
formula image: Possible option; CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasonography; FNA: Fine needle aspiration: D1/2/3/4: First, second, third, fourth portion of the duodenum; DJ: duodenojejunostomy
See this image and copyright information in PMC

References

    1. Joensuu H, DeMatteo RP. The management of gastrointestinal stromal tumors: a model for targeted and multidisciplinary therapy of malignancy. Annu Rev Med. 2012;63:247–258. - PMC - PubMed
    1. Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol. 2004;22(18):3813–3825. - PubMed
    1. Heinrich MC, Rubin BP, Longley BJ, et al. Biology and genetic aspects of gastrointestinal stromal tumors: KIT activation and cytogenetic alterations. Hum Pathol. 2002;33(5):484–495. - PubMed
    1. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51–58. - PMC - PubMed
    1. Schottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009;19(1):58–69. - PMC - PubMed

Publication types

LinkOut - more resources