Surgery for gastrointestinal stromal tumors of the duodenum

Duodenal gastrointestinal stromal tumors (GISTs) represent a unique dilemma with varied surgical treatment options. However, the impact of operative methods on disease recurrence has never been addressed.

We retrospectively reviewed the medical records of all patients with duodenal GISTs treated at our hospital from January 2001 to December 2008.

Of the 25 patients included for analysis, 9 had pancreaticoduodenectomy (PD) and 16 had limited operation. Comparison of clinicopathological data between tumors treated by PD and by limited operation showed no significant differences in patient age, sex, symptoms, location of tumor, tumor grade, immunohistochemical staining pattern, or complications after surgery. However, patients with tumors >5 cm (P = 0.005) or not diagnosed as GISTs before surgery (P = 0.004) were significantly more frequently treated by PD. In multivariable analysis, the only significant predictor for disease recurrence was high-risk duodenal GISTs.

Based on the fact that type of operation was not correlated to operative risk and disease recurrence, limited operation rather than PD should be attempted for duodenal GIST without involvement of papilla of Vater to preserve more pancreas parenchyma, duodenum, and common bile duct.