Pancreaticoduodenectomy versus local resection in the treatment of gastrointestinal stromal tumors of the duodenum

World Journal of Surgical Oncology

Shusen Zheng²  Jie Zhou¹  Sheng Yan²  Jian Wu²  Min Zhang²  Bo Zhou² 

[1] Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

关键词: Surgery;    Pancreaticoduodenectomy;    Local resection;    Duodenum;    Gastrointestinal stromal tumor (GIST);   

Others  :  823393
DOI  :  10.1186/1477-7819-11-196

 received in 2013-03-16, accepted in 2013-08-04,  发布年份 2013

【 摘 要 】

Background

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. However, duodenal GISTs compromise a small and rare subset and few studies have focused on them. We evaluated the surgical management of patients with duodenal GISTs treated by pancreaticoduodenectomy (PD) versus local resection (LR) in our institution and analyzed the postoperative outcomes.

Methods

This was a retrospective review of patients with duodenal GISTs managed in our institution from January 2006 to January 2012. Clinicopathologic findings and disease-free survival (DFS) of duodenal GIST patients were analyzed.

Results

A total of 48 patients were selected. The most common presentation was bleeding (60.4%), and the second portion of the duodenum (35.4%) was the most common dominant site. Of the patients, 34 (70.8%) underwent LR while 14 (29.2%) underwent PD. The surgical margins for all studied patients were free. Patients who ultimately underwent PD were more likely to present with a larger tumor (median size: PD, 6.3 cm vs LR, 4.0 cm; P = 0.02) and more commonly presented with a tumor in the second portion of the duodenum (second portion: PD, 64.3% vs LR, 23.5%; P = 0.007). The tumors treated by PD had a higher grade of risk compared with LR as defined by National Institutes of Health (NIH) criteria (P = 0.019). PD was significantly associated with a longer operation time and a longer hospital stay compared to LR (P < 0.001 and P = 0.001, respectively). In our study, the median follow-up period was 36 months (range: 0 to 81 months). The 1- and 3-year DFS was 100% and 88%, respectively. From multivariable analysis, the only significant factor associated with a worse DFS was an NIH high risk classification (hazard ratio = 4.24).

Conclusions

The recurrence of duodenal GIST was correlated to tumor biology rather than type of operation. PD was associated with a longer hospital stay and longer operation time. Therefore, LR with clear surgical margins should be considered a reliable and curative option for duodenal GIST and PD should be reserved for lesions not amenable to LR.

【 授权许可】

   
2013 Zhou et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Machairas A, Karamitopoulou E, Tsapralis D, Karatzas T, Machairas N, Misiakos EP: Gastrointestinal stromal tumors (GISTs): an updated experience. Dig Dis Sci 2010, 55:3315-3327.
• [2]Dei Tos AP, Laurino L, Bearzi I, Messerini L, Farinati F: Gastrointestinal stromal tumors: the histology report. Dig Liver Dis 2011, 43:S304-S309.
• [3]Winfield RD, Hochwald SN, Vogel SB, Hemming AW, Liu C, Cance WG, Grobmyer SR: Presentation and management of gastrointestinal stromal tumors of the duodenum. Am Surg 2006, 72:719-722.
• [4]Goh BK, Chow PK, Kesavan S, Yap WM, Wong WK: Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: is limited resection appropriate? J Surg Oncol 2008, 97:388-391.
• [5]Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, Sobin LH, Lasota J: Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 2003, 27:625-641.
• [6]Yang WL, Yu JR, Wu YJ, Zhu KK, Ding W, Gao Y, Shen QY, Lv KZ, Zhang Q, Yang XJ: Duodenal gastrointestinal stromal tumor: clinical, pathologic, immunohistochemical characteristics, and surgical prognosis. J Surg Oncol 2009, 100:606-610.
• [7]Tien YW, Lee CY, Huang CC, Hu RH, Lee PH: Surgery for gastrointestinal stromal tumors of the duodenum. Ann Surg Oncol 2010, 17:109-114.
• [8]Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, Song OP: Management and outcome of gastrointestinal stromal tumors of the duodenum. J Gastrointest Surg 2010, 14:880-883.
• [9]Johnston FM, Kneuertz PJ, Cameron JL, Sanford D, Fisher S, Turley R, Groeschl R, Hyder O, Kooby DA, Blazer D 3rd, Choti MA, Wolfgang CL, Gamblin TC, Hawkins WG, Maithel SK, Pawlik TM: Presentation and management of gastrointestinal stromal tumors of the duodenum: a multi-institutional analysis. Ann Surg Oncol 2012, 19:3351-3360.
• [10]Cubas RF, Ballarino EA, Nieto FA, Diaz MD: Local resection of a gastrointestinal stromal tumor of the third portion of the duodenum. Am Surg 2012, 78:E22-E23.
• [11]Cavallaro G, Polistena A, D’Ermo G, Pedullà G, De Toma G: Duodenal gastrointestinal stromal tumors: review on clinical and surgical aspects. Int J Surg 2012, 10:463-465.
• [12]Blay JY, Bonvalot S, Casali P, Choi H, Debiec Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray Coquard I, Reichardt P, Sciot R, Stroobants S, Van Glabbeke M, Van Oosterom A, Demetri GD: Consensus meeting for the management of gastrointestinal stromal tumors. report of the GIST consensus conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 2005, 16:566-578.
• [13]Machado NO, Chopra P, Al Haddabi IH, Al Qadhi H: Large duodenal gastrointestinal stromal tumor presenting with acute bleeding managed by a Whipple resection. a review of surgical options and the prognostic indicators of outcome. JOP 2011, 12:194-199.
• [14]Sakamoto Y, Yamamoto J, Takahashi H, Kokudo N, Yamaguchi T, Muto T, Makuuchi M: Segmental resection of third portion of duodenum for a gastrointestinal stromal tumor: a case report. Jpn J Clin Oncol 2003, 33:364-366.
• [15]Goh BK, Chow PK, Ong HS, Wong WK: Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J Surg Oncol 2005, 91:273-275.
• [16]Buchs NC, Bucher P, Gervaz P, Ostermann S, Pugin F, Morel P: Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum. World J Gastroenterol 2010, 16:2788-2792.
• [17]Beham A, Schaefer IM, Cameron S, Von Hammerstein K, Füzesi L, Ramadori G, Ghadimi MB: Duodenal GIST: a single center experience. Int J Colorectal Dis 2013, 28:581-590.
• [18]El-Gendi A, El-Gendi S, El-Gendi M: Feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. J Gastrointest Surg 2012, 16:2197-2202.
• [19]Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O’Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW: Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002, 33:459-465.
• [20]Cassier PA, Blay JY: Gastrointestinal stromal tumors of the stomach and duodenum. Curr Opin Gastroenterol 2011, 27:571-575.