Cancer Management and Research (2020-06-01)

Optimal Laparoscopic Management and Oncological Outcomes of Gastrointestinal Stromal Tumors in Duodenum: Pancreaticoduodenectomy or Pancreas-Sparing Duodenectomy?

  • Lu C,
  • Jin W,
  • Mou Y,
  • Shao H,
  • Wu X,
  • Li S,
  • Xu B,
  • Wang Y,
  • Zhu Q,
  • Xia T,
  • Zhou Y

Journal volume & issue
Vol. Volume 12
pp. 4725 – 4734

Abstract

Read online

Chao Lu,1– 3 Weiwei Jin,1,2 Yiping Mou,1,2 Hongliang Shao,4 Xiaosan Wu,4 Shaodong Li,5 Biwu Xu,4 Yuanyu Wang,1,2 Qicong Zhu,1,2 Tao Xia,1,2 Yucheng Zhou1– 3 1Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of China; 2Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou, Zhejiang Province, People’s Republic of China; 3School of Medicine, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 4School of Medicine, Bengbu Medical College, Bengbu, Anhui Province, People’s Republic of China; 5School of Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Yucheng Zhou; Yiping MouDepartment of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaEmail [email protected]; [email protected]: Gastrointestinal stromal tumors (GIST) of the duodenum are rarely reported and optimal minimally invasive management has not been well proposed. Pancreaticoduodenectomy and different types of pancreas-sparing duodenectomy can be chosen; however, which to choose and its corresponding clinical outcomes and oncological concerns remain controversial.Patients and Methods: Patients diagnosed with GIST of duodenum underwent laparoscopic pancreaticoduodenectomy (L-PD) or pancreas-sparing duodenectomy (L-PSD) in Zhejiang Provincial People’s Hospital were enrolled. All prospectively maintained data were analyzed retrospectively. Patients were grouped into the L-PD group or the L-PSD group, and the clinical outcomes and oncological outcomes were analyzed.Results: Between June 2013 and March 2019, a total of 22 patients (11 males/11 females) underwent surgical management, including 13 L-PDs and 9 L-PSDs. The average age was 58.2± 9.5 year-old (median 60.5 year-old). The most common presentations were GI bleeding (54.5%) and abdominal discomfort (27.2%), and the dominant lesion located in the second portion of duodenum (59.1%). Compared with L-PD group, L-PSD group showed much shorter operation time (364.2± 58.7min vs. 230.0± 12.3min, P< 0.001), less blood loss (176.9± 85.7mL vs. 61.1± 18.2min, P< 0.001), faster recovery to off-bed (2.6± 1.3d vs. 1.1± 0.3d, P=0.003), anus flatus (4.5± 1.0d vs. 2.4± 0.5d, P< 0.001) and liquid intake (4.9± 1.3d vs. 2.3± 0.5d, P< 0.001). Lymph node retrieval was much less in L-PSD, but no lymph node metastasis was observed in any patients. L-PSD had much Lower morbidity of both minor (Grade I/II) and major (III/IV/V) complications than that of L-PD (11.1% vs. 61.6%, P=0.02), resulting in shorter hospital stays (10.9± 3.8d vs. 20.6± 11.1d, P=0.021) and less total cost (76,972.4± 11,614.8yuan vs 125,628.7± 46,356.8yuan, P=0.006). The median follow-up was 42 months (range from 12 to 82months) without loss. Only 1 L-PD patient suffered hepatic metastasis 36months after surgery, and given sunitinib to stabilize the disease, none of the rest observed recurrence or metastasis.Conclusion: For GIST located opposite the major papilla, L-PSD showed comparable safety and oncological benefits when compared to L-PD, with shorter operation time, less blood loss and much faster recovery time, resulting in much less total cost. L-PSD should be applied in selected patients with experienced hands.Keywords: GIST, duodenum, pancreaticoduodenectomy, pancreas-sparing duodenectomy

Keywords