A new retrospective, single-center study found that localized resection of gastrointestinal stromal tumors (GISTs) in the second part of the duodenum (D2) was associated with low morbidity and middle-term outcomes similar to those of pancreaticoduodenectomy.

Therefore, the study authors suggest that “[localized resection] with safety margins confirmed by frozen section should be the treatment of choice for all patients with D2-GIST unless the papilla is involved as manifested by obstructive jaundice.”

Localized resection and pancreaticoduodenectomy showed comparable survival, disease-free survival, and recurrence rates. The 3-year cumulative survival rates were 92% for patients who underwent adjuvant imatinib therapy and 86% for patients who did not receive adjuvant therapy. However, they were comparable between the localized resection and pancreaticoduodenectomy groups (P =.71). The 3-year disease-free survival rates were 85% with localized resection and 92% with pancreaticoduodenectomy (P =.6).

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Pancreaticoduodenectomy had a longer operative time (308 ± 64 minutes vs 119 ± 27 minutes) and a higher incidence of postoperative pancreatic fistula (42%) than localized resection. The study authors did not identify any additional significant differences in the postoperative complications assessed (ie, delayed gastric emptying, chest infection, wound infection, and intra-abdominal abscess).

In addition, El-Haddad et al found a direct association between mitotic index and Miettinen risk.

This study included 53 patients (mean age, 55 ± 8 years; 60% female) diagnosed with nonmetastatic D2-GIST. Patients were treated with either localized resection (77%) or pancreaticoduodenectomy (23%), depending on Vater’s ampulla involvement. Patients were followed up for 3 years for middle-term outcomes assessment.

The D2 is the area most commonly affected by GIST, and it is also the most challenging for surgical intervention due to its close proximity to the head of the pancreas.


El-Haddad HM, Kassem MI, Shehata GA, El-Sayes IA. Outcome after surgical treatment of gastrointestinal stromal tumors in the second part of duodenum: is localized resection appropriate? J Investig Surg. Published online August 29, 2021. doi:10.1080/08941939.2021.1968081