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Clinical, Pathological and Surgical Characteristics of Duodenal Gastrointestinal Stromal Tumor and Their Influence on Survival: A Multi-Center Study

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The duodenum is a rare site of primary gastrointestinal stromal tumor (GIST). Overall (OS) and disease-free survival (DFS) after limited resection (LR) versus pancreaticoduodenectomy (PD) were studied.

Methods

All patients who underwent surgery for primary, localized duodenal GIST between 2000 and 2011 were identified from four prospective institutional databases. OS and DFS were calculated by Kaplan–Meier method. Univariate analysis was performed.

Results

Eighty-four patients (median follow-up 42 months) underwent LR (n = 56, 67 %) or PD (n = 28, 33 %). Patients in the PD group had a larger median tumor size (7 cm vs. 5 cm, p = 0.024) and higher mitotic count (39 % vs. 19 % >5/50 high-power fields, p = 0.05). Complications were observed in five patients (9 %) in the LR group and ten patients (36 %) in the PD group. OS and DFS for the entire cohort were 89 % and 64 % at 5 years, respectively. No difference in outcome between LR and PD were observed. Eleven patients were treated with preoperative IM. A major RECIST response was obtained in nine (80 %), whereas two had stable disease. Twenty-three patients received postoperative Imatinib (IM). A trend toward a better OS in IM-treated patients could be detected only in the high-risk group.

Conclusions

Type of duodenal resection does not impact outcome. The choice should be determined by duodenal site of origin and tumor size. IM may be considered in cases at high risk of recurrence; in neoadjuvant setting, IM might facilitate resection and possibly increase the chance of preserving normal biliary and pancreatic anatomy.

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Disclosures

C.P. Raut received honoraria from Novartis Pharma. U. Roenellenfitsch received travel supports from Novartis Pharma. P. Rukowski received honoraria and travel supports from Novartis Pharma and Pfizer; compensations for advisory boards from Novartis Pharma. P. Hohenberger received honoraria and compensations for advisory boards from Novartis Pharma. A. Gronchi received honoraria and compensations for advisory boards from Novartis Pharma.

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Authors and Affiliations

  1. Department of Surgery, Sarcoma Service, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    C. Colombo MD & A. Gronchi MD

  2. Division of Surgical Oncology & Thoracic Surgery Mannheim University Medical, Mannheim, Germany

    U. Ronellenfitsch MD & P. Hohenberger MD, PhD

  3. Department of Surgery, Brigham and Women’s Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA

    Z. Yuxin MD & C. P. Raut MD

  4. Department of Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China

    Z. Yuxin MD

  5. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

    P. Rutkowski MD & E. Bylina MD

  6. Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    R. Miceli PhD

Authors
  1. C. Colombo MD
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  2. U. Ronellenfitsch MD
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  3. Z. Yuxin MD
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  4. P. Rutkowski MD
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  5. R. Miceli PhD
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  6. E. Bylina MD
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  7. P. Hohenberger MD, PhD
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  8. C. P. Raut MD
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  9. A. Gronchi MD
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Corresponding author

Correspondence to A. Gronchi MD.

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Colombo, C., Ronellenfitsch, U., Yuxin, Z. et al. Clinical, Pathological and Surgical Characteristics of Duodenal Gastrointestinal Stromal Tumor and Their Influence on Survival: A Multi-Center Study. Ann Surg Oncol 19, 3361–3367 (2012). https://doi.org/10.1245/s10434-012-2559-0

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  • DOI: https://doi.org/10.1245/s10434-012-2559-0

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