Sung Hoon Choi, MD1, Ji Wool Ko, MD1, Chang Moo Kang, PhD2. 1CHA bundang medical center, CHA university, 2Yonsei University College of Medicine
Introduction: Although organ-preserving operation for duodenal gastrointestinal stromal tumor (GIST) has been regarded as reasonable strategy, laparoscopic pancreas-sparing subtotal duodenectomy(Lap PSSD) has been rarely reported. The aim of this study was to evaluate whether lap PSSD can be an appropriate surgical option as well as its technical feasibility.
Method: Between January 2011 and March 2016, 13 Lap PSSDs were performed for duodenal GIST. Demographics and surgical outcomes of the patients were reviewed. Subtotal duodenectomy was defined as distal duodenal resection of ampulla of Vater to first portion of jejunum. After resection, all patients underwent reconstruction as side-to-side duodenojejunostomy.
Results: The mean age of the patients was 52.9 years (range 20-75 years) and male to female proportion was 3 to 10. Seven tumors were located in the second, 3 in the third, 1 in the fourth portion of duodenum, and 2 in the first portion of jejunum were indicated for this procedure. Localization of ampulla of Vater was performed in 4 patients. The total mean operation time was 273 min (range 160-346 min) and estimated blood loss were 80 ml (range scanty-200 ml). One patient converted to open laparotomy because of mesocolonic involvement by the tumor. The median length of postoperative hospital stay was 10.5 days (range 4-36 days). There was no postoperative mortality. Postoperative complications included 2 delayed gastric empytings (DGE), 1 stricture of duodenojejunostomy, and 2 intestinal obstruction. No patient was treated with adjuvant therapy. One patient had hepatic metastasis on 28 months after surgery during the mean follow-up period of 37.5 months.
Conclusions: This study is the largest series of laparoscopic PSSD. This surgical option might be an oncologically reasonable strategy for duodenal GIST and laparoscopic approach is technically feasible and attractive surgical modality in safety of procedure and perioperative results. However, DGE and stricture of anastomosis are concerns of postoperative complication, which are needed to be further investigated for its cause and solution
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78644
Program Number: S151
Presentation Session: Minimally Invasive Surgery – World Tour
Presentation Type: Podium
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