Results from a study comparing open surgery and robotic surgery in duodenal gastrointestinal stromal tumors (DGISTs) demonstrated statistical and significant differences in estimated blood loss (EBL) and operation time (OT) between the 2 groups.

Further, no significant difference in postoperative complications occurred between the groups. These findings indicate that robotic surgery is a safe alternative method with a therapeutic effect that equals open surgical procedures.

Researchers calculated an average EBL of 62.3 ± 34.9 mL in the robotic surgical group and an average EBL of 340.0 ± 401.8 mL in the open surgical group (P =.01). The robotic DGIST surgeries averaged 156.0 ± 55.4 minutes, while the open DGIST surgeries averaged 207.7 ± 63.1 minutes. (P =.029).

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Postoperative complications included postoperative pancreatic fistula (POPF) in 9 cases, delayed gastric emptying (DGE) in 5 cases, and abdominal hemorrhaging in 2 cases. These complications occurred in 7 of 15 robotic surgical patients and 7 of 13 open surgical patients. Conservative treatment cured all complications.

Study Methods

Zhou et al compared 11 patients who received open surgery for DGIST with 17 patients who received robotic surgery for DGIST between May 1, 2010, and May 1, 2020. Two patients in the robotic group converted to open surgery (leaving 13 and 15 patients in the groups) because of the potential risk for tumor rupture during surgery, which elevates postoperative risk for metastasis.

Endoscopic ultrasound is critical in determining the size, scope, shape, location, and spread of the DGIST in relationship to the rest of the gastrointestinal tract. The most common location for DGISTs in this patient cohort was in the descending duodenum (16 patients, 57%) followed by the horizontal section of the duodenum (9 patients, 32%), the bulb section (2 patients, 7%), and lastly the ascending duodenum (1 patient, 4%).

Surgeons use these diagnostic findings to decide which type of surgery is most beneficial for the patient. In this study, they performed either a pancreatoduodenectomy (PD) (11 patients) or limited resection (17 patients) based on tumor location and proximity to the duodenal papilla. Guidelines recommend PD in cases where patients have difficulty with tumor dissection or tumors are less than 2 cm away from the duodenal papilla, which invade the pancreatic head, or have an association with the superior mesenteric artery and vein. Recommendations indicate limited resection for tumors more than 2 cm away from the duodenal papilla.

Postoperative Treatment

Surgeons successfully R0 resected all DGISTs regardless of surgical group, with all patients surviving during the follow-up period. Postoperative pathology reports indicated that 5 patients were medium grade for recurrence risk and 4 were high grade. Therefore, these 9 patients received imatinib as an adjuvant therapy for 3 years following resection of their tumors.

Four patients experienced recurrence and metastasis, with 3 cases of liver metastasis and 1 to the mesocolon, all of which were resected. Investigators noted no significant difference between the robotic and open surgical groups in recurrence-free survival rates.  

Research Limitations

Limitations to this study included the small sample size, with the authors suggesting “a large amount of case data should be accumulated in future research.” Regardless of limitations, the authors state, “robotic resection of DGISTS is safe and feasible and has the same therapeutic effect as traditional open surgery. Such surgery can be performed in suitable medical centers, which can reduce surgical trauma, accelerate postoperative rehabilitation, and provide more options for surgical treatment.”


Zhou Z-P, Tan X-L, Zhao Z-M, et al. Robotic resection of duodenal gastrointestinal stromal tumour: preliminary experience from a single centre. World J Gastrointest Oncol. 2021;13(7):706-715. doi:10.4251/wjgo.v13.i7.706