Optimal surgical procedure for duodenal gastrointestinal stromal tumors

Duodenal gastrointestinal stromal tumors are rare primary duodenal tumors, and there are few guidelines to help the clinician with their surgical management. A Switzerland research group reports a limited surgical operation to remove these tumors by segmental duodenectomy. The results were good with no complications and mortality. All the patients are still alive and disease-free, even after several years of follow up.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. However, the duodenal location is less common. Nowadays, surgery is still the only curative approach for GIST. Numerous procedures can be performed to remove duodenal GIST. Some of these operations are extensive and require difficult reconstruction (like pancreaticoduodenectomy; PD). One of the options is a more limited intervention: segmental duodenectomy (SD). However, few studies have correlated the different surgical options with the oncological results.

A research article to be published on June 14, 2010 in the World Journal of Gastroenterology addresses this question. A Switzerland research group has conducted this study to evaluate the outcomes after SD and PD. They found that SD was a reliable and curative option for most duodenal GISTs, and was compatible with long-term disease-free survival (DFS). On the other hand, PD remains a good alternative for tumors in the vicinity of the pancreas.

In the present study, the authors report good oncological outcomes with long-term DFS in the SD group. Thus, whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs.