Surgical strategy and outcomes in duodenal gastrointestinal stromal tumor Journal Article

Authors: Lee, S. Y.; Goh, B. K. P.; Sadot, E.; Rajeev, R.; Balachandran, V. P.; Gönen, M.; Kingham, T. P.; Allen, P. J.; D’Angelica, M. I.; Jarnagin, W. R.; Coit, D.; Wong, W. K.; Ong, H. S.; Chung, A. Y. F.; DeMatteo, R. P.
Article Title: Surgical strategy and outcomes in duodenal gastrointestinal stromal tumor
Abstract: Background: The surgical management of duodenal gastrointestinal stromal tumors (DGIST) is poorly characterized. Limited resection may be technically feasible and oncologically safe, but anatomic 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 two institutions from 1994 to 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, recurrence-free survival, and overall survival for the pancreaticoduodenectomy versus limited resection were 81 versus 56 % (p = 0.05), 64 versus 53 % (p = 0.5), and 76 versus 72 % (p = 0.6), respectively. A surgical algorithm based on the location and size of the tumor is proposed. Conclusions: 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. © 2016, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 24
Issue: 1
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2017-01-01
Start Page: 202
End Page: 210
Language: English
DOI: 10.1245/s10434-016-5565-9
PROVIDER: scopus
PMCID: PMC5199143
PUBMED: 27624583
Notes: Article -- Export Date: 3 January 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Ronald P DeMatteo
    602 DeMatteo
  2. Mithat Gonen
    716 Gonen
  3. Peter Allen
    442 Allen
  4. William R Jarnagin
    596 Jarnagin
  5. T Peter Kingham
    293 Kingham
  6. Daniel Coit
    422 Coit
  7. Ser Yee Lee
    9 Lee
  8. Eran Sadot
    36 Sadot
  9. Rahul   Rajeev
    1 Rajeev