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Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study.

Authors :
Dubois, Clément
Nuytens, Frederiek
Behal, Hélène
Gronnier, Caroline
Manceau, Gilles
Warlaumont, Maxime
Duhamel, Alain
Denost, Quentin
Honoré, Charles
Facy, Olivier
Tuech, Jean-Jacques
Tiberio, Guido
Brigand, Cécile
Bail, Jean-Pierre
Salame, Ephrem
Meunier, Bernard
Lefevre, Jérémie H.
Mathonnet, Muriel
Idrissi, Mohamed Sbai
Renaud, Florence
Source :
Annals of Surgical Oncology: An Oncology Journal for Surgeons; Oct2021, Vol. 28 Issue 11, p6294-6306, 13p
Publication Year :
2021

Abstract

Background: The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. Objectives: The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). Methods: In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. Results: Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. Conclusions: For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10689265
Volume :
28
Issue :
11
Database :
Complementary Index
Journal :
Annals of Surgical Oncology: An Oncology Journal for Surgeons
Publication Type :
Academic Journal
Accession number :
152604165
Full Text :
https://doi.org/10.1245/s10434-021-09862-7