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Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome.

Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J - BMC Surg (2015)

Bottom Line: The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively.The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060).No statistically significant difference was found among the three operation types (P = 0.294).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. scyshenchaoyong@163.com.

ABSTRACT

Background: Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. We here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST.

Methods: Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were retrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were calculated using Kaplan-Meier method.

Results: Out of 74 cases, 42 cases were female (56.76%) and 32 cases (43.24%) were male. Approximately 22.97, 47.30, 16.22, and 13.51% of the tumors originated in the first to fourth portion of the duodenum, respectively, with a tumor size of 5.08 ± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00%), abdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76%), and others (n = 7, 9.76%). A total of 18 patients (24.3%) underwent wedge resection (WR); 39 patients (52.7%) underwent segmental resection (SR); and 17 cases (23%) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1-159 months); 19 patients (25.68%) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69%, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively. The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294).

Conclusions: DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.

No MeSH data available.


Related in: MedlinePlus

a, b: The abdominal CT scan and endoscopic ultrasonography images reveal a soft tissue mass with size of 6.5 × 4.5 cm located in the second portion of the duodenum, and with an unclear boundary with head of pancreas, right liver, and kidney. c shows a metastasis in the liver at 44 months postoperatively. d: A lump with a size of 4.5 × 3.7 cm adjacent to pancreas. e, f: Liver (mainly in the right liver lobe) and bone (multiple bone destruction of ilium) metastasis occurred 12 years after operation
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Fig1: a, b: The abdominal CT scan and endoscopic ultrasonography images reveal a soft tissue mass with size of 6.5 × 4.5 cm located in the second portion of the duodenum, and with an unclear boundary with head of pancreas, right liver, and kidney. c shows a metastasis in the liver at 44 months postoperatively. d: A lump with a size of 4.5 × 3.7 cm adjacent to pancreas. e, f: Liver (mainly in the right liver lobe) and bone (multiple bone destruction of ilium) metastasis occurred 12 years after operation

Mentions: Table 1 shows the clinicopathological characteristics of the patients. One patient was diagnosed as DGIST preoperatively and had undergone complete tumor resection. However, liver metastasis had occurred at 44 months postoperatively (Fig. 1a–c). Two patients had distant metastasis at the time of diagnosis (a patient with left hepatic metastasis underwent complete resection; no recurrence or metastasis occurred after 25 months of follow-up; another patient had extensive abdominal metastasis and died at 26 months postoperatively). A total of 16 patients received tyrosine kinase inhibitor as adjuvant therapy and were treated for a median time of 28 months (1–52 months). Among them, 1 patient took SUTENT (sunitinib malate, because of intolerance of IM therapy) at 50 mg/d, and 15 patients took imatinib mesylate at 400 mg/day; 6 patients had mild eyelid edema, and 1 patient had mild abnormal liver function. However, these patients did not stop the medication. One patient underwent surgery with complete tumor resection after treatment with IM. However, liver metastasis occurred at 44 months postoperatively. The remaining cases refused to undergo adjuvant therapy mainly due to economic reasons.Table 1


Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome.

Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J - BMC Surg (2015)

a, b: The abdominal CT scan and endoscopic ultrasonography images reveal a soft tissue mass with size of 6.5 × 4.5 cm located in the second portion of the duodenum, and with an unclear boundary with head of pancreas, right liver, and kidney. c shows a metastasis in the liver at 44 months postoperatively. d: A lump with a size of 4.5 × 3.7 cm adjacent to pancreas. e, f: Liver (mainly in the right liver lobe) and bone (multiple bone destruction of ilium) metastasis occurred 12 years after operation
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536755&req=5

Fig1: a, b: The abdominal CT scan and endoscopic ultrasonography images reveal a soft tissue mass with size of 6.5 × 4.5 cm located in the second portion of the duodenum, and with an unclear boundary with head of pancreas, right liver, and kidney. c shows a metastasis in the liver at 44 months postoperatively. d: A lump with a size of 4.5 × 3.7 cm adjacent to pancreas. e, f: Liver (mainly in the right liver lobe) and bone (multiple bone destruction of ilium) metastasis occurred 12 years after operation
Mentions: Table 1 shows the clinicopathological characteristics of the patients. One patient was diagnosed as DGIST preoperatively and had undergone complete tumor resection. However, liver metastasis had occurred at 44 months postoperatively (Fig. 1a–c). Two patients had distant metastasis at the time of diagnosis (a patient with left hepatic metastasis underwent complete resection; no recurrence or metastasis occurred after 25 months of follow-up; another patient had extensive abdominal metastasis and died at 26 months postoperatively). A total of 16 patients received tyrosine kinase inhibitor as adjuvant therapy and were treated for a median time of 28 months (1–52 months). Among them, 1 patient took SUTENT (sunitinib malate, because of intolerance of IM therapy) at 50 mg/d, and 15 patients took imatinib mesylate at 400 mg/day; 6 patients had mild eyelid edema, and 1 patient had mild abnormal liver function. However, these patients did not stop the medication. One patient underwent surgery with complete tumor resection after treatment with IM. However, liver metastasis occurred at 44 months postoperatively. The remaining cases refused to undergo adjuvant therapy mainly due to economic reasons.Table 1

Bottom Line: The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively.The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060).No statistically significant difference was found among the three operation types (P = 0.294).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. scyshenchaoyong@163.com.

ABSTRACT

Background: Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited. We here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST.

Methods: Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were retrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were calculated using Kaplan-Meier method.

Results: Out of 74 cases, 42 cases were female (56.76%) and 32 cases (43.24%) were male. Approximately 22.97, 47.30, 16.22, and 13.51% of the tumors originated in the first to fourth portion of the duodenum, respectively, with a tumor size of 5.08 ± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00%), abdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76%), and others (n = 7, 9.76%). A total of 18 patients (24.3%) underwent wedge resection (WR); 39 patients (52.7%) underwent segmental resection (SR); and 17 cases (23%) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1-159 months); 19 patients (25.68%) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died. The 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69%, respectively. The 1-, 3- and 5-year OS were 100, 92.5, and 86%, respectively. The recurrence/metastasis-free survival rate in the PD group within 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group (P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294).

Conclusions: DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures should be determined by the DGIST tumor location and size.

No MeSH data available.


Related in: MedlinePlus