Laparoscopic Pancreas-Preserving Duodenal Resection for Duodenal Gist

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, commonly arising in the stomach (60-70%) or small intestine (20-30%). Duodenal GISTs are less common and present unique technical challenges for surgical management.^1,2 PATIENTS AND METHODS: This video presents the case of a 66-year-old woman with a primary, localized duodenal GIST, incidentally discovered in the second portion of the duodenum. Investigations confirmed a 27-mm KIT exon 9-mutated GIST. Due to its proximity to the ampulla, preoperative imatinib at 800 mg daily was initiated. After nine months of modest tumor shrinkage, surgery was proposed, but the patient opted to delay due to concerns about surgical morbidity. Given the tumor's stability, imatinib was continued until a laparoscopic resection was performed two years after starting imatinib, preserving both the pancreas and the ampulla. The duodenum was mobilized via a transmesocolic approach, with careful dissection from the pancreatic head. The first jejunal loop was transected, and the duodenum was divided just below the ampulla under direct endoscopic guidance. An intracorporeal, side-to-side, isoperistaltic, antecolic duodenojejunal anastomosis was performed.

Complete en-bloc resection with negative margins was achieved. The patient's recovery was uneventful, and she was discharged on postoperative day 7. The length of stay reflects institutional practices influenced by limited home support and patient travel needs.

This case illustrates the value of multidisciplinary planning and minimally invasive techniques for managing duodenal GISTs. Even with a modest response to imatinib, oncologically sound and anatomically conservative surgery can be achieved.