Surgery for duodenal gastrointestinal stromal tumor: A systematic review and meta-analysis of pancreaticoduodenectomy versus local resection

Zhou, Yanming; Wang, Xuefeng; Si, Xiaoying; Wang, Shijie; Cai, Zhibin

doi:10.1016/j.asjsur.2019.02.006

Cited by 19 publications

(10 citation statements)

References 36 publications

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“…Additionally, postoperative adjuvant treatment can result in a better prognosis[ 11 - 13 ]. In recent years, several clinical studies and meta-analyses have suggested that surgical resection of GISTs should adhere to the principle of local resection[ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2021

WJGO

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“…Dentro de las opciones se encuentran la resección local y la pancreatoduodenectomía. En este caso, en el acto quirúrgico, se observó una lesión exofítica ubicada entre la segunda y tercera porción del duodeno que infiltraba la cabeza del páncreas hasta el proceso uncinado por lo que se decide realizar una pancreatoduodenectomía, procedimiento más frecuentemente realizado cuando el GIST se encuentra en la segunda porción del duodeno 2,[8][9][10][11] . En el estudio con TC previo a la cirugía no se observaba compromiso vascular ni linfático por lo que no se realiza linfadenectomía.…”

Section: Resultsunclassified

GIST duodenal asociado a hemorragia digestiva alta. Reporte de caso.

et al. 2021

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Introducción: Los tumores del estroma gastrointestinal (GIST), corresponden al 1%, de todas las neoplasias gastrointestinales, sin embargo, solo el 3-5% de estos se desarrollan en el duodeno.Objetivo: Reportar el caso de un paciente masculino con localización atípica de un tumor de estroma gastrointestinal y su manejo.Caso clínico: paciente masculino de 50 años con antecedente de traumatismo encéfalo craneano (TEC) con daño orgánico cerebral secundario, tabaquismo, consumidor de alcohol ocasional y quistectomía branquial en infancia, que consulta en el servicio de urgencias por cuadro de hemorragia digestiva alta con compromiso hemodinámico. Tras realizar endoscopia digestiva alta (EDA), resonancia nuclear magnética (RNM) y tomografía computada (TC) de abdomen, se pesquisa masa tumoral en segunda porción de duodenal.Discusión: Se discuten las presentaciones clínicas más frecuentes de esta patología, así como la localización de este tipo de tumores. Se hace énfasis en el rol de las herramientas diagnósticas y en el tratamiento quirúrgico agresivo propuesto.

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“…Factors associated with an increased likelihood of requiring PD versus LR were larger tumors with higher mitotic count and location in the second portion of duodenum [ 56 , 57 ]. In the current study, patients who underwent PD tended to have larger tumors and tumor with higher mitotic count, whereas tumors located at second portion of duodenum were statistically more likely to require PD.…”

Section: Discussionmentioning

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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Surgery for duodenal gastrointestinal stromal tumor: A systematic review and meta-analysis of pancreaticoduodenectomy versus local resection

Cited by 19 publications

References 36 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

GIST duodenal asociado a hemorragia digestiva alta. Reporte de caso.

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

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