Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 270–279 | Cite as

Clinicopathologic Characteristics and Optimal Surgical Treatment of Duodenal Gastrointestinal Stromal Tumor

  • Seung Jae Lee
  • Ki Byung SongEmail author
  • Young-Joo Lee
  • Song Cheol Kim
  • Dae Wook Hwang
  • Jae Hoon Lee
  • Sang Hyun Shin
  • Jae Woo Kwon
  • Seung Hyun Hwang
  • Chung Hyeun Ma
  • Gui Suk Park
  • Ye Jong Park
  • Kwang-Min Park
Original Article



The clinicopathologic characteristics of duodenal gastrointestinal stromal tumor (GIST) were unclear and the optimal surgical procedure for duodenal GIST remains poorly defined. We aimed to analyze clinicopathological characteristics, survival outcomes based on the surgical procedure, and recommend optimal surgical treatment for duodenal GIST.


From July 2000 to April 2017, 118 patients with localized duodenal GIST underwent curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes.


The 5-year overall survival (OS) and disease-free survival (DFS) rates were 94.9 and 79.2%, respectively. On multivariate analysis, the mitotic count was a statistically significant prognostic factor for DFS. Limited resection (LR) was performed in 20 patients with GIST in the first or fourth portion of the duodenum. Both LR and pancreaticoduodenectomy (PD) were performed in 98 patients with GIST in second or third portion of the duodenum. The patients in the LR group had less late complications than in the PD group and no postoperative newly developed diabetes mellitus. The minimally invasive LR (MI-LR) group had a shorter duration of surgery and shorter length of postoperative hospital stay.


LR is a feasible and effective surgical treatment for patients with small-sized and antimesenteric-sided duodenal GIST in terms of late complications and postoperative diabetic complications. MI-LR has better perioperative outcomes than open LR. Therefore, we should consider MI-LR as an optimal surgical treatment for selected patients with duodenal GIST.


Duodenum Gastrointestinal stromal tumor Limited resection Pancreaticoduodenectomy Minimally invasive surgery 


Author’s Contributions

Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work were done by Seung Jae Lee, Ki Byung Song, Young-Joo Lee, Song Cheol Kim, Dae Wook Hwang, Jae Hoon Lee, Sang Hyun Shin, Jae Woo Kwon, Seung Hyun Hwang, Chung Hyeun Ma, Gui Suk Park, Ye Jong Park, and Kwang-Min Park. Drafting the work or revising it critically for important intellectual content was done by Seung Jae Lee and Ki Byung Song. Final approval of the version to be published was done by Seung Jae Lee and Ki Byung Song. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved was done by Seung Jae Lee and Ki Byung Song.


  1. 1.
    Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459–465.CrossRefGoogle Scholar
  2. 2.
    Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumour. Lancet 2007;369:1731–1741.CrossRefGoogle Scholar
  3. 3.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–58.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Iorio N, Sawaya RA, Friedenberg FK. Review article: the biology, diagnosis and management of gastrointestinal stromal tumours. Aliment Pharmacol Ther 2014;39:1376–1386.CrossRefGoogle Scholar
  5. 5.
    Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, Sobin LH, Lasota J. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 2003;27:625–641.CrossRefGoogle Scholar
  6. 6.
    Miki Y, Kurokawa Y, Hirao M, Fujitani K, Iwasa Y, Mano M, Nakamori S, Tsujinaka T. Survival analysis of patients with duodenal gastrointestinal stromal tumors. J Clin Gastroenterol 2010;44:97–101.CrossRefGoogle Scholar
  7. 7.
    Johnston FM, Kneuertz PJ, Cameron JL, Sanford D, Fisher S, Turley R, Groeschl R, Hyder O, Kooby DA, Blazer D, 3rd, Choti MA, Wolfgang CL, Gamblin TC, Hawkins WG, Maithel SK, Pawlik TM. Presentation and management of gastrointestinal stromal tumors of the duodenum: a multi-institutional analysis. Ann Surg Oncol 2012;19:3351–3360.CrossRefGoogle Scholar
  8. 8.
    Colombo C, Ronellenfitsch U, Yuxin Z, Rutkowski P, Miceli R, Bylina E, Hohenberger P, Raut CP, Gronchi A. Clinical, pathological and surgical characteristics of duodenal gastrointestinal stromal tumor and their influence on survival: a multi-center study. Ann Surg Oncol 2012;19:3361–3367.CrossRefGoogle Scholar
  9. 9.
    Goh BK, Chow PK, Kesavan S, Yap WM, Wong WK. Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: is limited resection appropriate? J Surg Oncol 2008;97:388–391.CrossRefGoogle Scholar
  10. 10.
    Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, Emile JF, Gronchi A, Hogendoorn PC, Joensuu H, Le Cesne A, McClure J, Maurel J, Nupponen N, Ray-Coquard I, Reichardt P, Sciot R, Stroobants S, van Glabbeke M, van Oosterom A, Demetri GD. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol 2005;16:566–578.CrossRefGoogle Scholar
  11. 11.
    Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumours. Br J Surg 2003;90:1178–1186.CrossRefGoogle Scholar
  12. 12.
    Marano L, Boccardi V, Marrelli D, Roviello F. Duodenal gastrointestinal stromal tumor: From clinicopathological features to surgical outcomes. Eur J Surg Oncol 2015;41:814–822.CrossRefGoogle Scholar
  13. 13.
    Mennigen R, Wolters HH, Schulte B, Pelster FW. Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST). World J Surg Oncol 2008;6:105.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Bourgouin S, Hornez E, Guiramand J, Barbier L, Delpero JR, Le Treut YP, Moutardier V. Duodenal gastrointestinal stromal tumors (GISTs): arguments for conservative surgery. J Gastrointest Surg 2013;17:482–487.CrossRefGoogle Scholar
  15. 15.
    Everett M, Gutman H. Surgical management of gastrointestinal stromal tumors: analysis of outcome with respect to surgical margins and technique. J Surg Oncol 2008;98:588–593.CrossRefGoogle Scholar
  16. 16.
    Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg 2009;96:567–578.CrossRefGoogle Scholar
  17. 17.
    Goh BK, Chow PK, Ong HS, Wong WK. Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J Surg Oncol 2005;91:273–275.CrossRefGoogle Scholar
  18. 18.
    Lanuke K, Bathe OF, Mack LA. Local excision of duodenal gastrointestinal stromal tumor. J Surg Oncol 2007;95:267–269.CrossRefGoogle Scholar
  19. 19.
    Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, Wakabayashi G. Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumors. Surgery 2010;147:516–520.CrossRefGoogle Scholar
  20. 20.
    Chung JC, Kim HC, Hur SM. Limited resections for duodenal gastrointestinal stromal tumors and their oncologic outcomes. Surg Today 2016;46:110–116.CrossRefGoogle Scholar
  21. 21.
    Zioni T, Dizengof V, Kirshtein B. Laparoscopic resection of duodenal gastrointestinal stromal tumour. J Minim Access Surg 2017;13:157–160.PubMedCentralGoogle Scholar
  22. 22.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–196.CrossRefGoogle Scholar
  23. 23.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Butt J, Rowley S, Byrne PJ, Reynolds JV. Management of gastrointestinal stromal tumours: a single-centre experience. Ir J Med Sci 2007;176:157–160.CrossRefGoogle Scholar
  25. 25.
    Kwon SH, Cha HJ, Jung SW, Kim BC, Park JS, Jeong ID, Lee JH, Nah YW, Bang SJ, Shin JW, Park NH, Kim DH. A gastrointestinal stromal tumor of the duodenum masquerading as a pancreatic head tumor. World J Gastroenterol 2007;13:3396–3399.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, Song OP. Management and outcome of gastrointestinal stromal tumors of the duodenum. J Gastrointest Surg 2010;14:880–883.CrossRefGoogle Scholar
  27. 27.
    Machado NO, Chopra PJ, Al-Haddabi IH, Al-Qadhi H. Large duodenal gastrointestinal stromal tumor presenting with acute bleeding managed by a whipple resection. A review of surgical options and the prognostic indicators of outcome. Jop 2011;12:194–199.Google Scholar
  28. 28.
    Chok AY, Koh YX, Ow MY, Allen JC, Jr, Goh BK. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 2014;21:3429–3438.CrossRefGoogle Scholar
  29. 29.
    Winfield RD, Hochwald SN, Vogel SB, Hemming AW, Liu C, Cance WG, Grobmyer SR. Presentation and management of gastrointestinal stromal tumors of the duodenum. Am Surg 2006;72:719–722; discussion 722-713.Google Scholar
  30. 30.
    Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J. Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome. BMC Surg 2015;15:98.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Bischof DA, Kim Y, Dodson R, Jimenez MC, Behman R, Cocieru A, Fisher SB, Groeschl RT, Squires MH, 3rd, Maithel SK, Blazer DG, 3rd, Kooby DA, Gamblin TC, Bauer TW, Quereshy FA, Karanicolas PJ, Law CH, Pawlik TM. Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients. JAMA Surg 2015;150:299–306.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Wada N, Takahashi T, Kurokawa Y, Nakajima K, Masuzawa T, Nakatsuka R, Kawada J, Nishida T, Kimura Y, Tanaka K, Miyazaki Y, Makino T, Yamasaki M, Takiguchi S, Mori M, Doki Y. Appropriate Follow-Up Strategies for Gastrointestinal Stromal Tumor Patients Based on the Analysis of Recurrent Interval and Patterns. Digestion 2017;95:115–121.CrossRefGoogle Scholar
  33. 33.
    Joensuu H, Vehtari A, Riihimaki J, Nishida T, Steigen SE, Brabec P, Plank L, Nilsson B, Cirilli C, Braconi C, Bordoni A, Magnusson MK, Linke Z, Sufliarsky J, Federico M, Jonasson JG, Dei Tos AP, Rutkowski P. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 2012;13:265–274.CrossRefGoogle Scholar
  34. 34.
    Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008;39:1411–1419.CrossRefGoogle Scholar
  35. 35.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70–83.CrossRefGoogle Scholar
  36. 36.
    Joensuu H, Martin-Broto J, Nishida T, Reichardt P, Schoffski P, Maki RG. Follow-up strategies for patients with gastrointestinal stromal tumour treated with or without adjuvant imatinib after surgery. Eur J Cancer 2015;51:1611–1617.CrossRefGoogle Scholar
  37. 37.
    Takahashi Y, Noguchi T, Takeno S, Uchida Y, Shimoda H, Yokoyama S. Gastrointestinal stromal tumor of the duodenal ampulla: report of a case. Surg Today 2001;31:722–726.CrossRefGoogle Scholar
  38. 38.
    Kim DJ, Lee JH, Kim W. Laparoscopic resection for 125 gastroduodenal submucosal tumors. Ann Surg Treat Res 2014;86:199–205.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Chen YH, Liu KH, Yeh CN, Hsu JT, Liu YY, Tsai CY, Chiu CT, Jan YY, Yeh TS. Laparoscopic resection of gastrointestinal stromal tumors: safe, efficient, and comparable oncologic outcomes. J Laparoendosc Adv Surg Tech A 2012;22:758–763.CrossRefGoogle Scholar
  40. 40.
    Dematteo RP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, Blackstein ME, Blanke CD, von Mehren M, Brennan MF, Patel S, McCarter MD, Polikoff JA, Tan BR, Owzar K. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009;373:1097–1104.CrossRefPubMedCentralGoogle Scholar
  41. 41.
    Huang HY, Huang WW, Lin CN, Eng HL, Li SH, Li CF, Lu D, Yu SC, Hsiung CY. Immunohistochemical expression of p16INK4A, Ki-67, and Mcm2 proteins in gastrointestinal stromal tumors: prognostic implications and correlations with risk stratification of NIH consensus criteria. Ann Surg Oncol 2006;13:1633–1644.CrossRefGoogle Scholar
  42. 42.
    Schneider-Stock R, Boltze C, Lasota J, Peters B, Corless CL, Ruemmele P, Terracciano L, Pross M, Insabato L, Di Vizio D, Iesalnieks I, Dirnhofer S, Hartmann A, Heinrich M, Miettinen M, Roessner A, Tornillo L. Loss of p16 protein defines high-risk patients with gastrointestinal stromal tumors: a tissue microarray study. Clin Cancer Res 2005;11:638–645.Google Scholar
  43. 43.
    Nakamura N, Yamamoto H, Yao T, Oda Y, Nishiyama K, Imamura M, Yamada T, Nawata H, Tsuneyoshi M. Prognostic significance of expressions of cell-cycle regulatory proteins in gastrointestinal stromal tumor and the relevance of the risk grade. Hum Pathol 2005;36:828–837.CrossRefGoogle Scholar
  44. 44.
    Feakins RM. The expression of p53 and bcl-2 in gastrointestinal stromal tumours is associated with anatomical site, and p53 expression is associated with grade and clinical outcome. Histopathology 2005;46:270–279.CrossRefGoogle Scholar
  45. 45.
    Yang WL, Yu JR, Wu YJ, Zhu KK, Ding W, Gao Y, Shen QY, Lv KZ, Zhang Q, Yang XJ. Duodenal gastrointestinal stromal tumor: clinical, pathologic, immunohistochemical characteristics, and surgical prognosis. J Surg Oncol 2009;100:606–610.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Seung Jae Lee
    • 1
  • Ki Byung Song
    • 1
    Email author
  • Young-Joo Lee
    • 1
  • Song Cheol Kim
    • 1
  • Dae Wook Hwang
    • 1
  • Jae Hoon Lee
    • 1
  • Sang Hyun Shin
    • 1
  • Jae Woo Kwon
    • 1
  • Seung Hyun Hwang
    • 1
  • Chung Hyeun Ma
    • 1
  • Gui Suk Park
    • 1
  • Ye Jong Park
    • 1
  • Kwang-Min Park
    • 1
  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulSouth Korea

Personalised recommendations