Laparoscopic pancreaticoduodenectomy for Duodenal GIST

Jia-Yu Zhou, MD¹, Wei-Wei Jin, MD¹, Yi-Ping Mou, MD², Xiao-Wu Xu, MD², Ren-Chao Zhang, MD², Yu-Cheng Zhou, MS², Chao-Jie Huang², Chao Lu¹, Rong-Gao Chen¹, Jing-Rui Wang¹. ¹Zhejiang University, ²Zhejiang Provincial People Hospital

Background

The incidence of duodenal location of stromal tumors is rare. The optimal surgical procedure for  GISTs has not been well characterized. The aim of this study is to describe perioperative and  follow-up outcomes of laparoscopic pancreaticoduodenectomy (LPD) for Duodenal GIST.

Material and Methods

From January 2013 to September 2015, there were 13 patients with duodenal GIST received LPD in a single institution.  All the medical record were retrospectively reviewed. Demographic data, clinicopathological features, surgical outcomes, postoperative complications, mortality and follow-up results were prospectively recorded.

Results

In the study, 13 patients underwent LPD for duodenal GIST , 5 male and 8 female, with a median age of 59 years old. Patients presented with gastrointestinal bleeding (n = 6, 46.16 %), Incidentally found (n =3, 23.08 %), abdominal mass (n =2, 15.38 %), abdominal pain (n = 1, 7.69%), and GI Obstruction (n = 1, 7.69%). The tumors originated in the first to fourth portion of the duodenum were 23.10%, 38.46%, 23.10% and 15.34 % ,respectively. The mean size of tumor was 5.6(3.0-8.4)cm. Median operative time was 375 min and median blood loss was 185 ml. Based on the NIH risk criteria,patients exhibited low risk(n=4 30.77%), intermediate risk(n=3 23.08%), and high risk(n=6 46.15%). All the surgical margins were negative (R0 resection). Median postoperative hospital stay was 10 days. Overall 30-day morbidity rate was 56 % (48% Clavien 2 or less). No mortality has been found. During a follow-up of 19 (2-32) mo, the 1-year and 2-year recurrence/metastasis-free survival rates was 100% and 86%, respectively. In this study, 9 of 13 patients received postoperative adjuvant imatinib, and one of them developed multiple  liver metastasis within one year after the operation due to stop taking imatinib.

Conclusions

Laparoscopic pancreaticoduodenectomy is a safe, feasible and effective surgical procedure for duodenal GIST.