Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2021; 13(8): 959-969
Published online Aug 15, 2021. doi: 10.4251/wjgo.v13.i8.959
Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors
Yun-Zi Wu, Yang Li, Ming Wu, Xiao-Hao Zheng, Yan-Tao Tian, Yi-Bin Xie
Yun-Zi Wu, Yang Li, Xiao-Hao Zheng, Yan-Tao Tian, Yi-Bin Xie, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ming Wu, Department of Gastric Surgery, Yun Cheng Center Hospital, Yucheng 043300, Shanxi Province, China
Author contributions: Wu YZ, Xie YB and Li Yang designed the study; Wu YZ and Wu Ming performed the research; Wu YZ and Zheng YH analyzed the data; Wu YZ and Li Yang wrote the paper; Xie YB and Tian YT revised the manuscript for final submission.
Supported by CAMS Initiative for Innovative Medicine, No. 2016-I2M-1-007.
Institutional review board statement: The study was reviewed and approved by the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All study participants or their legal guardian provided written informed consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no financial or personal relationships with other individuals or organizations that inappropriately influenced our work and that there is no professional or other personal interest of any nature in any product, service and/or company that could be construed as influencing the position presented in or the review of the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Bin Xie, MD, Chief Doctor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan South Lane, Chaoyang District, Beijing 100021, China. yibinxie_2003@163.com
Received: June 9, 2021
Peer-review started: June 9, 2021
First decision: June 15, 2021
Revised: June 18, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: August 15, 2021
Processing time: 66 Days and 9.6 Hours
Abstract
BACKGROUND

Duodenal gastrointestinal stromal tumor (DGIST) is a rare tumor with a specific anatomic site and biological characteristics. As the incidence of lymph node metastasis is very low, the main treatment method is surgery. Two main surgical techniques (local resection and Whipple) are performed in patients with DGISTs. The critical question is which surgical technique to choose.

AIM

To identify factors influencing the choice of surgery for DGISTs.

METHODS

The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed. We used the Student’s t-test or Mann-Whitney U-test and the χ2 test or Fisher’s exact test to determine the differences between the two groups of patients. Furthermore, we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery. The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors.

RESULTS

Overall, 86 patients were analyzed, including 43 men (50%) and 43 women (50%). We divided the patients into two groups based on surgical technique (local resection or Whipple surgery). There were no differences in the age, mitotic figures, and complications between the two groups; however, the tumor size, tumor location, risk grade, postoperative hospital stay, and abdominal drainage time were significantly different. Based on univariate logistic analysis, the Whipple procedure was chosen if the tumor size was ≥ 5.0 cm, the tumor was located in the descending part of the duodenum, or the risk grade was medium or high. In our research, the five-year overall survival rate of patients was more than 90%. We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases.

CONCLUSION

The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum, tumor size was ≥ 5.0 cm, or the tumor risk grade was medium or high.

Keywords: Duodenal gastrointestinal stromal tumors; Whipple; Surgery; Tumor size; Tumor risk grade

Core Tip: We investigated the factors influencing the surgical treatment of duodenal gastrointestinal stromal tumors, and found that if the primary tumor was in the descending part of the duodenum, tumor size was ≥ 5.0 cm and tumor risk grade was medium or high, Whipple surgery was performed.