Skip to main content

Advertisement

Log in

Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Introduction

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3–5% of all GISTs and represent 10–30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding.

Cases

We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma.

Discussion

Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD.

Conclusion

The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

GISTs:

Gastrointestinal stromal tumours

GI:

Gastrointestinal

PD:

Pancreaticoduodenectomy

CT:

Computed tomography

NIH:

National Institutes of Health

LR:

Local resection

EUS:

Endoscopic ultrasound

MRI:

Magnetic resonance imaging

References

  1. Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23:70–83 

    Article  PubMed  Google Scholar 

  2. Gold JS, Gönen M, Gutiérrez A et al (2009) Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol 10:1045–1052

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cirocchi R, Farinella E, La Mura F et al (2010) Efficacy of surgery and imatinib mesylate in the treatment of advanced gastrointestinal stromal tumor: a systematic review. Tumori 96:392–399

    PubMed  Google Scholar 

  4. Mennigen R, Wolters HH, Schulte B et al (2008) Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST). World J Surg Oncol 6:105

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shaw A, Jeffery J, Dias L et al (2013) Duodenal wedge resection for large gastrointestinal stromal tumor presenting with life-threatening haemorrhage. Case Reports in Gastrointestinal Medicine, Article ID, p 562642

    Google Scholar 

  6. Demetri GD, Von Mehren M, Antonescu CR et al (2010) NCCN task force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 8(Suppl 2):S1–S41

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Pidhorecky I, Cheney RT, Kraybill WG et al (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7:705–712

    Article  CAS  PubMed  Google Scholar 

  8. Rammohan A, Sathyanesan J, Rajendran K et al (2013) A gist of gastrointestinal stromal tumors: a review. World J Gastrointest Oncol 5:102–112

    Article  PubMed  PubMed Central  Google Scholar 

  9. Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumors. Br J Surg 90:1178–1186

    Article  CAS  PubMed  Google Scholar 

  10. Kamath AS, Sarr MG, Nagorney DM et al (2012) Gastrointestinal stromal tumor of the duodenum: single institution experience. HPB (Oxford) 14:772–776

    Article  Google Scholar 

  11. Rabin I, Chikman B, Lavy R et al (2009) Gastrointestinal stromal tumors: a 19 year experience The. Israel Med Assoc J 11:98–102

    Google Scholar 

  12. Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465

    Article  PubMed  Google Scholar 

  13. Agaimy A (2010) Gastrointestinal stromal tumors (GIST) from risk stratification systems to the new TNM proposal: more questions than answers? A review emphasizing the need for a standardized GIST reporting. Int J Clin Exp Pathol 3:461–471

    PubMed  PubMed Central  Google Scholar 

  14. Hassan I, You YN, Shyyan R et al (2008) Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol 15:52–59

    Article  PubMed  Google Scholar 

  15. Miki Y, Kurokawa Y, Hirao M et al (2010) Survival analysis of patients with duodenal gastrointestinal stromal tumors. J Clin Gastroenterol 44:97–101

    Article  PubMed  Google Scholar 

  16. Zhou L, LiuC Bai J G et al (2012) A rare giant gastrointestinal stromal tumor of the stomach traversing the upper abdomen: a case report and literature review. World J Surg Oncol 10:66

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kitabayashi K, Seki T, Kishimoto K et al (2001) A spontaneously ruptured gastric stromal tumor presenting as generalized peritonitis: report of a case. Surg Today 31:350–354

    Article  CAS  PubMed  Google Scholar 

  18. Winfield RD, Hochwald SN, Vogel SB et al (2006) Presentation and management of gastrointes-tinal stromal tumors of the duodenum. Am Surg 72:719–722

    PubMed  Google Scholar 

  19. Johnston FM, Kneuertz PJ, Cameron JL et al (2012) Presentation and management of gastrointestinal stromal tumors of the duodenum: a multi-institutional analysis. Ann Surg Oncol 19:3351–3360

    Article  PubMed  Google Scholar 

  20. Blay JY, Bonvalot S, Casali P et al (2005) Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 16:566–578

    Article  PubMed  Google Scholar 

  21. Schwameis K, Fochtmann A, Schwameis M et al (2013) Surgical treatment of GIST an institutional experience of a high volume center. Int J Surg 11:801–806

    Article  PubMed  Google Scholar 

  22. Fletcher CD, Berman JJ, Corless C et al (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465

    Article  PubMed  Google Scholar 

  23. Joensuu H, Fletcher C, Dimitrijevic S et al (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3:655–664

    Article  CAS  PubMed  Google Scholar 

  24. Bourgouin S, Hornez E, Guiramand J et al (2013) Duodenal gastrointestinal stromal tumors (GISTs): arguments for conservative surgery. J Gastrointest Surg 17:482–487

    Article  PubMed  Google Scholar 

  25. Chung JC, Chu CW, Cho GS et al (2010) Management and outcome of gastrointestinal stromal tumours of the duodenum. J Gastrointest Surg 14:880–883

    Article  PubMed  Google Scholar 

  26. Goh BKP, Chow PKH, Kesavan S et al (2008) Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: Is limited resection appropriate? J Surg Oncol 97:388–391

    Article  PubMed  Google Scholar 

  27. Bourgouin S, Hornez E, Guiramand J et al (2013) Duodenal Gastrointestinal Stromal Tumors (GISTs): arguments for Conservative Surgery. J Gastrointest Surg 17:482–487

    Article  PubMed  Google Scholar 

  28. Parisi A, Desiderio J, Trastulli S et al (2014) Robotic pancreaticoduodenectomy in a case of duodenal gastrointestinal stromal tumor. World J Surg Oncol 12:372

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pidhorecky I, Cheney RT, Kraybill WG et al (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7:705–712

    Article  CAS  PubMed  Google Scholar 

  30. Yang Feng, Jin C, Du Z et al (2013) Duodenal gastrointestinal stromal tumor: clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg 206:360–367

    Article  PubMed  Google Scholar 

  31. Tien YW, Lee CY, Huang CC et al (2010) Surgery for gastrointestinal stromal tumors of the duodenum. Ann Surg Oncol 17:109–114

    Article  PubMed  Google Scholar 

  32. Amato B, Sivero L, Vigliotti G et al (2013) Surgery for cancer in the elderly: state of the art. Chirurgia (Turin) 26:313–315

    Google Scholar 

  33. Rispoli C, Rocco N, Iannone L et al (2009) Developing guidelines in geriatric surgery: role of the grade system. BMC Geriatr 9(Suppl. 1):A99

    Google Scholar 

  34. Amato B, Donisi M, Rispoli C et al (2013) Enhanced recovery after surgery (ERAS) program in the elderly: Is it feasible? Chirurgia (Turin) 26:307–308

    Google Scholar 

  35. Parisi A, Coratti F, Cirocchi R et al (2014) Robotic distal pancreatectomy with or without preservation of spleen: a technical not. World J Surg Oncol 12:29

    Article  Google Scholar 

  36. Desiderio J, Trastulli S, Cirocchi R et al (2013) Robotic gastric resection of large gastrointestinal stromal tumors. Int J Surg 11:191–196

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors declare that they have received no funding for the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roberto Cirocchi.

Ethics declarations

Conflict of interest

All authors listed have contributed sufficiently to the project to be included as authors, and to the best of our knowledge, no conflict of interest, financial or other exists.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any study with animals performed by any of the authors.

Informed consent

Informed consent to the radiological and surgical procedure and to the processing of own personal data was obtained from each individual study participant. In accordance with Italian Drug Agency (AIFA) guidelines, observational studies using retrospective data or materials do not require formal approval by the local ethics committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boselli, C., Cirocchi, R., Gemini, A. et al. Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature. Aging Clin Exp Res 29 (Suppl 1), 1–6 (2017). https://doi.org/10.1007/s40520-016-0641-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-016-0641-3

Keywords

Navigation