Impact of Surgical Modalities on Long-term Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumor

Wei, You-Zhu; Cai, Zhibin; Zhu, Chen-Long; Zhou, Yanming; Zhang, Xiaofeng

doi:10.1245/s10434-020-09497-0

Cited by 9 publications

(10 citation statements)

References 10 publications

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“…Multicenter analysis and high standard meta-analysis are necessary. As reported in previous research[ 24 , 25 ], based on our results, primary tumor size, primary tumor location and the risk grade can affect the surgical procedure. The critical point of tumor size should be further identified using a more effective statistical model[ 26 ].…”

Section: Discussionsupporting

confidence: 79%

Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors

et al. 2021

WJGO

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BACKGROUND Duodenal gastrointestinal stromal tumor (DGIST) is a rare tumor with a specific anatomic site and biological characteristics. As the incidence of lymph node metastasis is very low, the main treatment method is surgery. Two main surgical techniques (local resection and Whipple) are performed in patients with DGISTs. The critical question is which surgical technique to choose. AIM To identify factors influencing the choice of surgery for DGISTs. METHODS The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed. We used the Student’s t -test or Mann-Whitney U -test and the χ 2 test or Fisher’s exact test to determine the differences between the two groups of patients. Furthermore, we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery. The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors. RESULTS Overall, 86 patients were analyzed, including 43 men (50%) and 43 women (50%). We divided the patients into two groups based on surgical technique (local resection or Whipple surgery). There were no differences in the age, mitotic figures, and complications between the two groups; however, the tumor size, tumor location, risk grade, postoperative hospital stay, and abdominal drainage time were significantly different. Based on univariate logistic analysis, the Whipple procedure was chosen if the tumor size was ≥ 5.0 cm, the tumor was located in the descending part of the duodenum, or the risk grade was medium or high. In our research, the five-year overall survival rate of patients was more than 90%. We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases. CONCLUSION The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum, tumor size was ≥ 5.0 cm, or the tumor risk grade was medium or high.

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Section: Discussionsupporting

confidence: 79%

Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors

et al. 2021

WJGO

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“…Factors associated with OS and DFS did include tumor size, mitotic count, risk classification, and IM administration [ 1 , 32 , 34 , 54 , 66 ]. In our study, a trend for better OS and DFS in the subgroup of patients with smaller tumor size (<5 cm) and lower mitotic count (<5/50 HPFs) was observed.…”

Section: Discussionmentioning

confidence: 99%

“…More studies in the literature addressing the topic of duodenal GIST are limited by case reports [ 1 , 10 , 11 , 12 , 13 , 14 , 15 ] and small study populations [ 7 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. More rarely, there are larger single-/multi-institutional experiences [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

Vassos

Perrakis

Hohenberger

et al. 2021

JCM

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Background: Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. Methods: We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12–140). Results: A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42–77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5–13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. Conclusion: The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.

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“…Propensity score matching performed after adjusting covariates and the type of surgery did not show any significant impact of the OS and disease-specific survival. These results may argue that surgical modalities do not have significant impact on long-term survival outcomes in patients with D-GISTs and should be dependent on tumor location and size[ 67 ].…”

Section: Discussionmentioning

confidence: 99%

Current surgical management of duodenal gastrointestinal stromal tumors

Lim¹

2021

WJGS

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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.

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Impact of Surgical Modalities on Long-term Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumor

Cited by 9 publications

References 10 publications

Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors

Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors

Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

Current surgical management of duodenal gastrointestinal stromal tumors

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