Local Resection for Duodenal Gastrointestinal Stromal Tumors

• Published in: The American journal of surgery 2016-05, Vol.211 (5), p.867-870
• Main Authors: Crown, Angelena, MD, Biehl, Thomas R., MD, Rocha, Flavio G., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Classification; Colectomy - methods; Colectomy - mortality; Databases, Factual; Disease-Free Survival; Duodenal Neoplasms - diagnosis; Duodenal Neoplasms - mortality; Duodenal Neoplasms - surgery; Duodenoscopy - methods; Duodenum; Duodenum - surgery; Endosonography - methods; Female; Gastrointestinal Stromal Tumors - diagnosis; Gastrointestinal Stromal Tumors - mortality; Gastrointestinal Stromal Tumors - surgery; Gastrointestinal tumor; Humans; Laparoscopy; Local resection; Male; Middle Aged; Morbidity; Multimodal Imaging - methods; Neoplasm Invasiveness - pathology; Neoplasm Staging; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Prognosis; Retrospective Studies; Risk Assessment; Studies; Surgery; Survival Analysis; Tomography, X-Ray Computed - methods; Tumors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.02.006

Abstract Background Duodenal gastrointestinal tumors (GIST) present infrequently and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of lymphatic and submucosal spread and anatomic location near the bile duct and pancreas, the optimal approach for resection is unknown. Options include local resection, segmental resection and pancreaticoduodenectomy. Methods All cases of gastrointestinal stromal tumors originating from the duodenum between 2000-2015 were identified from administrative databases. Clinical and pathologic information was abstracted from the medical record and compared between patients who received local resection versus pancreaticoduodenectomy. Chi-square with Fisher’s exact test was used to detect differences between groups. Results Fifteen patients met the inclusion criteria of which 7 had a local resection (LR) and 8 had a pancreaticoduodenectomy (PD). The second portion of the duodenum was the most common origin of GIST in PD group while the third portion was most common in the LR group. Patients who underwent LR tended to be younger but there was no difference in tumor size, mitotic rate, margin positivity, readmission rate or recurrence. PD was associated with more complications, higher blood loss, and longer length of stay. Conclusions Local resection is a reasonable option for resection of duodenal gastrointestinal tumors and should be routinely considered if technically feasible.