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Local Resection for Duodenal Gastrointestinal Stromal Tumors
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 re...
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Published in: | The American journal of surgery 2016-05, Vol.211 (5), p.867-870 |
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description | 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. |
doi_str_mv | 10.1016/j.amjsurg.2016.02.006 |
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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.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2016.02.006</identifier><identifier>PMID: 27033254</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>The American journal of surgery, 2016-05, Vol.211 (5), p.867-870</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-b5a07d0c78ba467a8917a7afb404d7348e0dcb08d2145abb328b9408410723913</citedby><cites>FETCH-LOGICAL-c378t-b5a07d0c78ba467a8917a7afb404d7348e0dcb08d2145abb328b9408410723913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27033254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Crown, Angelena, MD</creatorcontrib><creatorcontrib>Biehl, Thomas R., MD</creatorcontrib><creatorcontrib>Rocha, Flavio G., MD</creatorcontrib><title>Local Resection for Duodenal Gastrointestinal Stromal Tumors</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Classification</subject><subject>Colectomy - methods</subject><subject>Colectomy - mortality</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Duodenal Neoplasms - diagnosis</subject><subject>Duodenal Neoplasms - mortality</subject><subject>Duodenal Neoplasms - surgery</subject><subject>Duodenoscopy - methods</subject><subject>Duodenum</subject><subject>Duodenum - surgery</subject><subject>Endosonography - methods</subject><subject>Female</subject><subject>Gastrointestinal Stromal Tumors - diagnosis</subject><subject>Gastrointestinal Stromal Tumors - mortality</subject><subject>Gastrointestinal Stromal Tumors - surgery</subject><subject>Gastrointestinal tumor</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Local resection</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Multimodal Imaging - methods</subject><subject>Neoplasm Invasiveness - pathology</subject><subject>Neoplasm Staging</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Pancreaticoduodenectomy - mortality</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Studies</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Tumors</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqFkdtKxDAQhoMouq4-grLgjTetk8M2KYginmFBcNfrkKZZSW0bTVrBtzd1VwVvvBr-4Z_TNwgdYEgx4OykSlVThd4_pyTKFEgKkG2gERY8T7AQdBONAIAkeYZhB-2GUEWJMaPbaIdwoJRM2QidzpxW9eTRBKM769rJ0vnJVe9K08b0rQqdd7btTOjskJhH2cS46Bvnwx7aWqo6mP11HKOnm-vF5V0ye7i9v7yYJZpy0SXFVAEvQXNRKJZxJXLMFVfLggErOWXCQKkLECXBbKqKghJR5AwEw8AJzTEdo-NV31fv3vq4i2xs0KauVWtcHyTmgjPOIV49Rkd_rJXrfVz9y5VhxjPKomu6cmnvQvBmKV-9bZT_kBjkgFdWco1XDnglEBnxxrrDdfe-aEz5U_XNMxrOVwYTcbxb42XQ1rTalNZHwLJ09t8RZ3866Nq2Nj7pxXyY8HuNDLFAzocfDy_GGQUQhNFPMYuhGQ</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Crown, Angelena, MD</creator><creator>Biehl, Thomas R., MD</creator><creator>Rocha, Flavio G., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Local Resection for Duodenal Gastrointestinal Stromal Tumors</title><author>Crown, Angelena, MD ; Biehl, Thomas R., MD ; Rocha, Flavio G., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-b5a07d0c78ba467a8917a7afb404d7348e0dcb08d2145abb328b9408410723913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Classification</topic><topic>Colectomy - methods</topic><topic>Colectomy - mortality</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Duodenal Neoplasms - diagnosis</topic><topic>Duodenal Neoplasms - mortality</topic><topic>Duodenal Neoplasms - surgery</topic><topic>Duodenoscopy - methods</topic><topic>Duodenum</topic><topic>Duodenum - surgery</topic><topic>Endosonography - methods</topic><topic>Female</topic><topic>Gastrointestinal Stromal Tumors - diagnosis</topic><topic>Gastrointestinal Stromal Tumors - mortality</topic><topic>Gastrointestinal Stromal Tumors - surgery</topic><topic>Gastrointestinal tumor</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Local resection</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Multimodal Imaging - methods</topic><topic>Neoplasm Invasiveness - pathology</topic><topic>Neoplasm Staging</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Pancreaticoduodenectomy - mortality</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Studies</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Crown, Angelena, MD</creatorcontrib><creatorcontrib>Biehl, Thomas R., MD</creatorcontrib><creatorcontrib>Rocha, Flavio G., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Crown, Angelena, MD</au><au>Biehl, Thomas R., MD</au><au>Rocha, Flavio G., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local Resection for Duodenal Gastrointestinal Stromal Tumors</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>211</volume><issue>5</issue><spage>867</spage><epage>870</epage><pages>867-870</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27033254</pmid><doi>10.1016/j.amjsurg.2016.02.006</doi><tpages>4</tpages></addata></record> |
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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 |
title | Local Resection for Duodenal Gastrointestinal Stromal Tumors |
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