Robotic Treatment for Large Duodenal Gastrointestinal Stromal Tumor

  • Alessandra Marano
  • Fabrizio Allisiardi
  • Enrico Perino
  • Luca Pellegrino
  • Paolo Geretto
  • Felice BorghiEmail author
Gastrointestinal Oncology



Duodenal gastrointestinal stromal tumors (D-GISTs) represent a rare entity.1 Surgery is the primary treatment choice for localized or potentially resectable D-GISTs. The main principle is the complete excision of the lesion with microscopically negative margins, without performing lymph node dissection.2 Nevertheless, the best surgical choice is still controversial since the strategy depends not only on the tumor size but also on its anatomic location.3,4 As a result, surgical management ranges from a major resection such as pancreaticoduodenectomy to more conservative procedures.5, 6, 7, 8 This video presents a duodenal sparing robotic resection of a large GIST of the second-third duodenal portion.


A 49-year-old healthy female complained episodes of melena. Endoscopy with endoscopic ultrasound identified a 6-cm lesion of the second-third portion of the duodenum with recent bleeding, arising from muscolaris propria. A computed tomography scan confirmed a large mass suspected to be a GIST without metastases or involvement of the ampulla of Vater. On the basis of these findings, after a multidisciplinary consultation, she was offered robotic surgery with a radical intent.


A duodenal-sparing da Vinci®Si™ resection with robot-sewn primary duodenal closure was performed. After an uneventful postoperative course, the patient was discharged on post-operative day 7. Final pathology revealed a high-grade risk D-GIST with free margins: adjuvant Imatinib was recommended.9 At 4 years follow-up, no recurrence has been detected.


A robotic approach might be considered in cases of large D-GISTs amenable to a conservative R0 surgery. This system provides several technical advantages that facilitate otherwise complex resection and reconstruction.10



The authors thank Mrs Anna Racca for her significant contribution to revising the manuscript.


The authors declare that they have no conflicts of interest or financial ties to disclose.

Supplementary material

The video was awarded the Best Video Award at 12th International Gastric Cancer Congress (IGCC), Beijing, 20–23 April 2017. Supplementary material 1 (MP4 238519 kb)


  1. 1.
    Ma GL, Murphy JD, Martinez ME, Sicklick JK. Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study. Cancer Epidemiol Biomarkers Prev. 2015;24(1):298–302.CrossRefGoogle Scholar
  2. 2.
    Network NCC (2019); Guidelines soft tissue sarcoma. [Accessed February 4, 2019].
  3. 3.
    Lee SY, Goh BK, Sadot E, et al. Surgical strategy and outcomes in duodenal gastrointestinal stromal tumor. Ann Surg Oncol. 2017;24(1):202–210.CrossRefGoogle Scholar
  4. 4.
    Lee SJ, Song KB, Lee YJ, et al. Clinicopathologic characteristics and optimal surgical treatment of duodenal gastrointestinal stromal tumor. J Gastrointest Surg. 2019;23(2):270–279.CrossRefGoogle Scholar
  5. 5.
    El-Gendi A, El-Gendi S, El-Gendi M. Feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. J Gastrointest Surg. 2012;16(12):2197–2202.CrossRefGoogle Scholar
  6. 6.
    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(11):3429–3438.CrossRefGoogle Scholar
  7. 7.
    Krishnamurthy G, Singh H, Sharma V, Savlania A, Vasishta RK. Therapeutic challenges in the management of bleeding duodenal gastrointestinal stromal tumor: a case report and review of literature. J. Gastrointest Cancer. 2019;50(1):170–174.CrossRefGoogle Scholar
  8. 8.
    Huang Y, Chen G, Lin L, et al. Resection of GIST in the duodenum and proximal jejunum: a retrospective analysis of outcomes. Eur. J. Surg. Oncol. 2019;45(10):1950–1956.CrossRefGoogle Scholar
  9. 9.
    Laurent M, Brahmi M, Dufresne A, et al. Adjuvant therapy with imatinib in gastrointestinal stromal tumors (GISTs)—review and perspectives. Transl Gastroenterol Hepatol. 2019;4:24.CrossRefGoogle Scholar
  10. 10.
    Downs-Canner S, Van Der Vliet WJ, Thoolen SJ, et al. Robotic surgery for benign duodenal tumors. J. Gastrointest. Surg. 2015;19(2):306–312.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Alessandra Marano
    • 1
  • Fabrizio Allisiardi
    • 1
  • Enrico Perino
    • 1
  • Luca Pellegrino
    • 1
  • Paolo Geretto
    • 1
  • Felice Borghi
    • 1
    Email author
  1. 1.General and Oncologic Surgery Unit, Department of SurgerySanta Croce e Carle HospitalCuneoItaly

Personalised recommendations