Novel insight into the epidemiological, clinical, and therapeutic data of gastrointestinal stromal tumors (GISTs) of the duodenum may lead to unified recommendations on their management and that of other primary duodenal malignant tumors (PDMT), according to a study recently published in the Journal of Gastrointestinal Oncology.
“In this retrospective study, we sought to analyze and evaluate the surgical procedure for PDMTs including pancreaticoduodenectomy (PD) and limited resection (LR) . . . to inform the management of PDMT,” the authors wrote.
This retrospective study included 94 patients diagnosed with PDMTs at a single center in China between 2014 and 2019. Of these, 32 patients had a duodenal GIST, accounting for 34.1% of the sample.
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Other subtypes included duodenal adenocarcinoma in 63.8% of cases and duodenal lymphoma in 2.1% of cases. Although the descending (D2) portion of the duodenum was the most frequent location of PDMTs, 50% of GISTs occurred in other segments.
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Interestingly, a distinguishing characteristic was that almost half (46.9%) of individuals with GIST in segments other than D2 presented with anemia as their main symptom.
Pancreaticoduodenectomy was the procedure most frequently performed (71.3%) as the main therapeutic approach. The alternative surgical technique was limited resection.
The main factor that influenced the choice of procedure was likely the location of the tumor since 87.1% of all pancreaticoduodenectomies were performed for PDMTs in the D2 segment. Conversely, tumors in other segments accounted for 59.4% of the limited resections.
The majority (68.7%) of patients with GIST underwent a limited resection. Statistical analysis demonstrated a significant relationship between the choice of surgical procedure and tumor diameter, with pancreaticoduodenectomy more frequently performed for larger tumors.
Importantly, there were no differences in pancreatic invasion, mitotic count, or risk stratification between the patients that underwent each surgery.
“Thus, LR should be used as the surgical treatment for non-D2 GIST patients with small tumor diameters,” the authors concluded.
Reference
Zhao Z, Zhang J, Li C, Liu T, Li W. Surgical treatment and survival analysis of primary duodenal malignant tumor: a retrospective cohort study. J Gastrointest Oncol. 2022;13(4):1733-1745. doi:10.21037/jgo-22-475
