Current surgical management of duodenal gastrointestinal stromal tumors

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.

Gastrointestinal Stromal Tumor (GIST): About 3 Cases

“…The management of patients with gastrointestinal stromal tumors (GISTs) involves a multidisciplinary team that includes pathologists, medical oncologists, surgeons, anaesthesiologists, and imaging experts. Four standard treatment approaches are utilized: [5,10,12].…”

“…Tumors in the small and large bowel typically require bowel anastomosis after resection, which can be performed using intracorporal or extracorporeal suturing or stapling. [5,6,9,12].…”

“…[1,2,3]. These tumors can range in size from less than 1 cm to more than 40 cm, with an average size of 5 cm at the time of clinical diagnosis [4,5,6].…”

“…Neurofibromatosis type 1 4. Familial GISTs, which involve germline mutations in C-KIT or PDGFRA and often present with multiple tumors [5,7].…”

Advances of endoscopic and surgical management in gastrointestinal stromal tumors

“…Operative procedure to completely remove tumor securing an adequate margin remains to be the optimal choice for radical cure in localized primaries with resectable feasibility. However, the complex and special anatomical position of the duodenum itself, which is contiguous with the head of pancreas, common bile duct, pancreatic duct, mesenteric blood vessels, and ampulla of Vater combined with relatively insufficient procedural experience owing to its rarity, brings about enormous challenge for performing the surgery ( 71 , 72 ). The available operative approaches based on diverse instruments primarily consist of open surgery, endoscopy, laparoscopy, and hybrid surgery such as endo–laparoscopic cooperative procedure.…”