Feasibility and Oncological Outcomes of Limited Duodenal Resection in Patients with Primary Nonmetastatic Duodenal GIST
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ORIGINAL ARTICLE
Feasibility and Oncological Outcomes of Limited Duodenal Resection in Patients with Primary Nonmetastatic Duodenal GIST Ahmed El-Gendi & Saba El-Gendi & Mohamed El-Gendi
Received: 9 August 2012 / Accepted: 12 September 2012 / Published online: 25 September 2012 # 2012 The Society for Surgery of the Alimentary Tract
Abstract Introduction Duodenal gastrointestinal stromal tumors (GISTs) are rare but still represent approximately 30 % of primary duodenal tumors. This study aimed to audit the feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. Methods Twelve patients who underwent surgery at our institution since 2002 were prospectively followed up. The duodenal GISTs were located in the first (n03), second (n01), third (n03), and fourth of duodenum (n01). Involving both D1/D2 (n02), D2/D3 (n01), and D3/D4 (n01). The primary endpoint for this analysis was disease-free survival. Results The commonest presentation was melena and anemia (83 %). All the patients underwent limited resection; six wedge resections with primary closures and six segmental resections with end-to-end anastomosis. The median tumor size was 8 cm (range, 5–16 cm). According to Fletcher scale, two GISTs were low risk, while 10 patients were intermediate and high risk. The latter received adjuvant therapy. All the patients had a complete resection with no postoperative mortality. One patient had three liver metastases 4 months after limited resection and had partial hepatectomy. After median follow-up of 45 (15–78)months, all patients are alive and disease free. Conclusion(s) When technically feasible, limited resection should be considered a reliable and curative option for duodenal GIST achieving satisfactory disease-free survival. The technical feasibility is guided by the tumor size, possible adjacent organ involvement, and its exact anatomical location. Keywords Gastrointestinal stromal tumor . Duodenal neoplasms . Segmental duodenectomy, limited resection
This manuscript was accepted as poster presentation in the American College of Surgeons 2012 Annual Clinical Congress scheduled for September 30–October 4 2012, at McCormick Place in Chicago, IL, USA. A. El-Gendi (*) : M. El-Gendi Department of Surgery, Faculty of Medicine, Alexandria University, El Sultan Hussein Street, El-Azarita, Khartom Square, Alexandria 21131, Egypt e-mail: [email protected] S. El-Gendi Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors arising within the gastrointestinal tract.1 Although GISTs are encountered all along the digestive tract, the most frequent sites of occurrence are the stomach (50 %) and small bowel (30 %). Duodenal GISTs are less frequent and account for 5 cm) were located below the infraampullary portion of the duodenum. Although these procedures are relatively simply to perform, there is a risk of subsequent anastomotic leakage, as well
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