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Multicenter Study
. 2021 Oct;28(11):6294-6306.
doi: 10.1245/s10434-021-09862-7. Epub 2021 Apr 10.

Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study

Clément Dubois #  1 , Frederiek Nuytens #  2 , Hélène Behal  3 , Caroline Gronnier  4 , Gilles Manceau  5 , Maxime Warlaumont  1 , Alain Duhamel  3 , Quentin Denost  4 , Charles Honoré  6 , Olivier Facy  7 , Jean-Jacques Tuech  8 , Guido Tiberio  9 , Cécile Brigand  10 , Jean-Pierre Bail  11 , Ephrem Salame  12 , Bernard Meunier  13 , Jérémie H Lefevre  14 , Muriel Mathonnet  15 , Mohamed Sbai Idrissi  16 , Florence Renaud  17   18 , Guillaume Piessen  1   18 ; AFC and FREGAT Working Group
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Free article
Multicenter Study

Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study

Clément Dubois et al. Ann Surg Oncol. 2021 Oct.
Free article

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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References

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