Feasibility and Oncological Outcomes of Limited Duodenal Resection in Patients with Primary Nonmetastatic Duodenal GIST

El-Gendi, Ahmed; El-Gendi, Saba; El-Gendi, M.

doi:10.1007/s11605-012-2034-z

Cited by 25 publications

(34 citation statements)

References 31 publications

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“…Furthermore, PD was significantly associated with a longer operation time and a longer hospital stay compared to LR. Collectively, these data indicate that LR might be a reliable and curative option for a significant subset of patients with duodenal GIST, which is in accordance with the report of El-Gendi [18]. …”

Section: Discussionsupporting

confidence: 91%

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

Zhou

Zhang

et al. 2013

World J Surg Onc

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BackgroundGastrointestinal 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.MethodsThis 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.ResultsA 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).ConclusionsThe 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.

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Section: Discussionsupporting

confidence: 91%

“…This is similar to previous reports, which showed that the DFS rate at 1 to 3 years after a complete surgical resection, for all kinds of resection, varies from 86% to 100% [8,13,16,18]. Prognosis and recurrence are mainly dependent on tumor biology, which is determined by size and mitotic index (Fletcher scale) [19].…”

Section: Discussionsupporting

confidence: 89%

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

Zhou

Zhang

et al. 2013

World J Surg Onc

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“…Although pancreaticoduodenectomy is generally safe and associated with low mortality in specialized centers, its associated morbidity remains. 11, 12 Here, we analyze the 20-year experience of the surgical management of DGIST of 2 referral centers, including technical aspects as well as short- and long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor

et al. 2016

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Introduction The surgical management of duodenal gastrointestinal stromal tumors (DGIST) is poorly characterized. Limited resection may be technically feasible and oncologically safe, but anatomical 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 2 institutions from 1994–2014 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 (RpFS), recurrence-free survival (RFS), and overall survival (OS) for the pancreaticoduodenectomy vs. limited resection were 81% vs. 56% (p = 0.05), 64% vs. 53% (p = 0.5), and 76% vs. 72% (p = 0.6), respectively. A surgical algorithm based on the location and size of the tumor is proposed. Conclusion 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.

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“…These systems are di cult to solve analytically.In this paper we consider the systems of linear functional di erential equations [1][2][3][4][5][6][7][8][9] including the term y(αx + β) and advance-delay in derivatives of y . To obtain the approximate solutions of those systems, we present a matrixcollocation method by using Müntz-Legendre polynomials and the collocation points.…”

Section: Introductionmentioning

confidence: 99%

“…In physics, chemistry, biology and engineering, a lot of problems are modelled by di erential equations, delay differential equations [10][11][12][13] and their systems [1][2][3][4][5][6][7][8][9][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

A numerical method for solving systems of higher order linear functional differential equations

2016

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Abstract:Functional di erential equations have importance in many areas of science such as mathematical physics. These systems are di cult to solve analytically.In this paper we consider the systems of linear functional di erential equations [1][2][3][4][5][6][7][8][9] including the term y(αx + β) and advance-delay in derivatives of y . To obtain the approximate solutions of those systems, we present a matrixcollocation method by using Müntz-Legendre polynomials and the collocation points. For this purpose, to obtain the approximate solutions of those systems, we present a matrix-collocation method by using Müntz-Legendre polynomials and the collocation points. This method transform the problem into a system of linear algebraic equations. The solutions of last system determine unknown coe cients of original problem. Also, an error estimation technique is presented and the approximate solutions are improved by using it. The program of method is written in Matlab and the approximate solutions can be obtained easily. Also some examples are given to illustrate the validity of the method.

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Feasibility and Oncological Outcomes of Limited Duodenal Resection in Patients with Primary Nonmetastatic Duodenal GIST

Abstract: When technically feasible, limited resection should be considered a reliable and curative option for duodenal GIST achieving satisfactory disease-free survival. The technical feasibility is guided by the tumor size, possible adjacent organ involvement, and its exact anatomical location.

Cited by 25 publications

References 31 publications

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

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

Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor

A numerical method for solving systems of higher order linear functional differential equations

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