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Annals of Surgical Oncology

, Volume 20, Issue 2, pp 547–547 | Cite as

Laparoscopic Pancreas-Sparing Subtotal Duodenectomy in Gastrointestinal Stromal Tumor of the Duodenum

  • Sung Hoon KimEmail author
  • Chang Moo Kang
  • Woo Jung Lee
Gastrointestinal Oncology

Abstract

Background

The duodenum is a rare origin for gastrointestinal stromal tumors (GISTs).1 , 2 A decision of pancreatoduodenectomy or limited resection is a dilemma for surgeons. Recent reviews have suggested that types of surgery did not influence prognosis and limited resection was indicated for small GIST located some distance away from the ampulla of Vater (AOV).3 , 4 However, a laparoscopic, pancreas-preserving, subtotal duodenectomy was rarely performed.5 , 6

Methods

A 20-year-old female was referred to our institution because of a duodenal submucosal mass. Computer tomography and endoscopy revealed a 3.8-cm–sized mass that was ∼2 cm from AOV. A minimally invasive and function-preserving resection was scheduled.

Results

Meticulous dissection of the duodenum from the pancreatic head was a critical point. Even small breakages of vessels could provoke massive bleeding, possibly resulting in the surgeon’s view being obstructed, longer operating times, or a decreased chance of performing a minimally invasive and limited resection. Therefore, an especially meticulous and careful dissection was performed. An upper gastrointestinal series revealed no leakage, and the patient received a soft diet on postoperative day 3. The patient was discharged on postoperative day 8. Pathologic examination reported a low-risk GIST group.

Conclusions

Although clearly malignant tumors are not suitable for this approach due to poor oncologic outcomes, laparoscopic pancreas-preserving subtotal duodenectomy is a feasible and effective strategy to treat benign or borderline tumors. This approach will offer successful oncologic results and laparoscopic merits. We feel that this demonstration would advocate clinical feasibility of minimally invasive and function-preserving resections in well-selected duodenal GISTs.

Keywords

Gastrointestinal Stromal Tumor Longe Operating Time Careful Dissection Gastrointestinal Series Soft Diet 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

DISCLOSURE

Sung Hoon Kim, Chang Moo Kang, and Woo Jung Lee have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 149931 kb)

References

  1. 1.
    Goh BKP, Chow PKH, 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;97:388–91.PubMedCrossRefGoogle Scholar
  2. 2.
    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; 72:719–22.PubMedGoogle Scholar
  3. 3.
    Cassier PA, Blay JY. Gastrointestinal stromal tumors of the stomach and duodenum. Curr Opin Gastroenterol. 2011;27:571–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg. 2009;96:567–78.PubMedCrossRefGoogle Scholar
  5. 5.
    Poves I, Burdio F, Alonso S, Seoane A, Grande L. Laparoscopic pancreas-sparing subtotal duodenectomy. J Pancreas. 2011;12: 62–5.Google Scholar
  6. 6.
    Dholakia C, Gould J. Minimally invasive resection of gastrointestinal stromal tumors. Surg Clin North Am. 2008;88:1009–18.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Sung Hoon Kim
    • 1
    Email author
  • Chang Moo Kang
    • 2
    • 3
  • Woo Jung Lee
    • 2
    • 3
  1. 1.Department of SurgeryWonju Christian Hospital, Yonsei University Wonju College of MedicineWonjuKorea
  2. 2.Division of Hepatobiliary and Pancreas, Department of SurgeryYonsei University College of MedicineSeoulKorea
  3. 3.Pancreaticobiliary Cancer ClinicInstitute of Gastroenterology, Yonsei University Health SystemSeoulKorea

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