Annals of Surgical Oncology

, Volume 17, Issue 1, pp 109–114 | Cite as

Surgery for Gastrointestinal Stromal Tumors of the Duodenum

  • Yu-Wen Tien
  • Chih-Yuan Lee
  • Chun-Chieh Huang
  • Rey-Heng Hu
  • Po-Huang Lee
Gastrointestinal Oncology



Duodenal gastrointestinal stromal tumors (GISTs) represent a unique dilemma with varied surgical treatment options. However, the impact of operative methods on disease recurrence has never been addressed.


We retrospectively reviewed the medical records of all patients with duodenal GISTs treated at our hospital from January 2001 to December 2008.


Of the 25 patients included for analysis, 9 had pancreaticoduodenectomy (PD) and 16 had limited operation. Comparison of clinicopathological data between tumors treated by PD and by limited operation showed no significant differences in patient age, sex, symptoms, location of tumor, tumor grade, immunohistochemical staining pattern, or complications after surgery. However, patients with tumors >5 cm (P = 0.005) or not diagnosed as GISTs before surgery (P = 0.004) were significantly more frequently treated by PD. In multivariable analysis, the only significant predictor for disease recurrence was high-risk duodenal GISTs.


Based on the fact that type of operation was not correlated to operative risk and disease recurrence, limited operation rather than PD should be attempted for duodenal GIST without involvement of papilla of Vater to preserve more pancreas parenchyma, duodenum, and common bile duct.


Common Bile Duct Gastrointestinal Stromal Tumor Wedge Resection Segmental Resection Limited Operation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999;23:82–7.CrossRefPubMedGoogle Scholar
  2. 2.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Pidhorecky L, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. 2000;7:705–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Pathol. 2002;10:81–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Antonescu CR, Viale A, Sarran, et al. Gene expression in gastrointestinal stromal tumors is distinguished by KIT genotype and anatomic site. Clin Cancer Res. 2004;10:3282–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Sakamoto Y, Yamamoto J, Takahashi H, et al. Segmental resection of third portion of duodenum for a gastrointestinal stromal tumor: a case report. Jpn J Clin Oncol. 2003;33:364–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Connolley EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumors. Br J Surg. 2003;90:1178–86.CrossRefGoogle Scholar
  8. 8.
    Uehara K, Hasegawa H, Ogiso S, et al. Gastrointestinal stromal tumor of the duodenum: diagnosis and treatment. Geka (Surg). 2001;63:1058–61.Google Scholar
  9. 9.
    Winfield RD, Hochwald SN, Vogel SB, Hemming AW, Liu C, Cance WG, Grobmyer SR. Presentation and management of gastrointestinal stromal tumors of the duodenum. Am Surg. 2006;72:719–23.PubMedGoogle Scholar
  10. 10.
    Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, Sobin LH, Lasota J. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum. Am J Sur Pathol. 2003;27:625–41.CrossRefGoogle Scholar
  11. 11.
    Tien Y-W, Wu Y-M, Liu K-L, Ho C-M, Lee P-H. Angiography is indicated for every sentinel bleed after pancreaticoduodenectomy. Ann Surg Oncol. 2008;15:1855–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Singer S, Rubin BP, Lux ML, et al. Prognostic value of Kit mutation type, mitotic activity, and histologic subtype in gastrointestinal stromal tumors. J Clin Oncol. 2002;20:3898–905.CrossRefPubMedGoogle Scholar
  13. 13.
    Pierie JP, Choudry U, Muzikansky A, et al. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg. 2001;136:383–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim CJ, Day S, Yeh KA. Gastrointestinal stromal tumors: analysis of clinical and pathologic factors. Am Surg. 2001;67:135–7.PubMedGoogle Scholar
  15. 15.
    Samiian L, Weaver M, Velanoovich V. Evaluation of gastrointestinal stromal tumors for recurrence rates and patterns of long-term follow-up. Am Surg. 2004;70:187–91.PubMedGoogle Scholar
  16. 16.
    Brainard JA, Goldblum JR. Stromal tumors of the jejunum and ileum: a clinicopathogic study of 39 cases. Am J Surg Pathol. 1997;21:407–16.CrossRefPubMedGoogle Scholar
  17. 17.
    Chang MS, Choe G, Kim WH, Kim YI. Small intestinal stromal tumors: a clinicopathologic study of 31 tumors. Pathol Int. 1998;48:341–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Crosby JA, Catton CN, Davis A, et al. Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol. 2001;8:50–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Huges JA, Cook JV, Said A, et al. Gastrointestinal stromal tumor of the duodenum in a 7-year-old boy. Pediatr Radiol. 2004;34:1024–7.CrossRefGoogle Scholar
  20. 20.
    Hompes D, Topal B, Ectors N, et al. Gastrointestinal tumour of the duodenum: extreme presentation in two cases. Acta Chir Belg. 2004;104:110–3.PubMedGoogle Scholar
  21. 21.
    De Marco G, Roviello F, Marrelli D, et al. A clinical case of duodenal gastrointestinal stromal tumor with a peculiarity in the surgical approach. Tumori. 2005;91:273–5.Google Scholar
  22. 22.
    Goh BK, Chow PK, Ong HS, Wong WK. Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J Surg Oncol. 2005;91:273–5.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Yu-Wen Tien
    • 1
  • Chih-Yuan Lee
    • 1
  • Chun-Chieh Huang
    • 2
  • Rey-Heng Hu
    • 1
  • Po-Huang Lee
    • 1
  1. 1.Department of SurgeryNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan, ROC
  2. 2.Department of PathologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan, ROC

Personalised recommendations