Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: Is limited resection appropriate?

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Introduction: Gastrointestinal stromal tumors (GIST) involving the duodenum are rarely reported. The present surgical opinions is divided regarding the optimal method for the resection of duodenal GIST with some investigators supporting the selective use of limited resection (LR) versus others who prefer pancreaticoduodenectomy (PD).
 Methods: A retrospective review of 22 patients who underwent surgery for a GIST or suspected GIST involving the duodenum at a single institution was performed. Comparison was made between GIST versus other non-GIST benign submucosal tumors and between results of LR versus PD.
 Results: There were 15 GISTs, 1 leiomyosarcoma and 6 other non-GIST benign submucosal tumors. 20 patients underwent curative resection including 7 PDs and 13 LRs. Surgery with palliative intent was performed in 2 patients with advanced duodenal leiomyosarcoma and GIST respectively. All 7 PDs were performed for GIST and all 6 patients with benign non-GIST submucosal tumors underwent LR. Comparison between the clinicopathological features of GIST and other benign tumors demonstrated that patient demographics and clinical presentation were similar and that size was the only statistically significant distinguishing factor. Comparison between LR versus PD demonstrated that LR was associated with a significantly shorter operation time but both had similar morbidity and mortality rates. Seven patients with GIST underwent LR and 7 underwent PD. The median follow-up of the 14 patients was 42 (range, 2-174) months and all were alive at follow-up. The long-term outcomes of patients who underwent LR versus PD were similar in terms of disease-specific specific survival and recurrence rates. Two patients (1 moderate risk and 1 high risk GIST) who underwent PD and 1 patient (high risk GIST) who underwent LR developed recurrences and all 3 recurrences occurred at distant sites.
 Conclusion: Benign non-GIST submucosal tumors should always be considered in the differential diagnosis of small duodenal submucosal tumors. LR is a viable treatment option in patients with suspected GIST involving the duodenum provided that complete resection with clear margins can be obtained. PD should be reserved for patients where LR is not technically feasible.