Clément Dubois1, Frederiek Nuytens2, Hélène Behal3, Caroline Gronnier4, Gilles Manceau5, Maxime Warlaumont1, Alain Duhamel3, Quentin Denost4, Charles Honoré6, Olivier Facy7, Jean-Jacques Tuech8, Guido Tiberio9, Cécile Brigand10, Jean-Pierre Bail11, Ephrem Salame12, Bernard Meunier13, Jérémie H Lefevre14, Muriel Mathonnet15, Mohamed Sbai Idrissi16, Florence Renaud17,18, Guillaume Piessen1,18. 1. Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France. 2. Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France. frederiek.nuytens@gmail.com. 3. University Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France. 4. Department of Digestive Surgery, Haut Lévêque University Hospital, Bordeaux, France. 5. Department of Digestive Surgery, Pitié-Salpêtrière University Hospital, Paris, France. 6. Department of Surgery, Institut Gustave Roussy, Villejuif, France. 7. Department of Digestive Surgery, Dijon University Hospital, Dijon, France. 8. Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France. 9. General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 10. Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France. 11. Department of Digestive Surgery, Brest University Hospital, Brest, France. 12. Department of Digestive Surgery, Tours University Hospital, Tours, France. 13. Department of Digestive Surgery, Pontchailloux University Hospital, Rennes, France. 14. Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France. 15. Department of Digestive Surgery, Limoges University Hospital, Limoges, France. 16. Department of Digestive Surgery, Clinique Claude Bernard RAMSAY, Ermont, France. 17. Department of Pathology, Lille University Hospital, Lille, France. 18. University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.
Abstract
BACKGROUND: The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. OBJECTIVES: The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). METHODS: In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. RESULTS: Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. CONCLUSIONS: For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
BACKGROUND: The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. OBJECTIVES: The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). METHODS: In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. RESULTS: Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. CONCLUSIONS: For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
Authors: Pierre A Clavien; Jeffrey Barkun; Michelle L de Oliveira; Jean Nicolas Vauthey; Daniel Dindo; Richard D Schulick; Eduardo de Santibañes; Juan Pekolj; Ksenija Slankamenac; Claudio Bassi; Rolf Graf; René Vonlanthen; Robert Padbury; John L Cameron; Masatoshi Makuuchi Journal: Ann Surg Date: 2009-08 Impact factor: 12.969