Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1166-1179
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1166
Current surgical management of duodenal gastrointestinal stromal tumors
Kheng Tian Lim
Kheng Tian Lim, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Author contributions: Lim KT conceptualized and designed the review, carried out the analysis, drafted the initial manuscript; The author reviewed and approved the final manuscript as submitted.
Conflict-of-interest statement: Author declares no conflict of interests for this article.
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:
Corresponding author: Kheng Tian Lim, FRCS (Gen Surg), MBChB, MCh, Assistant Professor, Surgeon, Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
Received: May 9, 2021
Peer-review started: May 9, 2021
First decision: June 23, 2021
Revised: June 30, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: October 27, 2021

Duodenal gastrointestinal stromal tumors (D-GISTs) are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors. They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater, pancreas, mesenteric blood vessels, biliary and pancreatic ducts. The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved. The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location, size and involvement of surrounding structures such as wedge resection with primary closure, segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy. Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands. The minimally invasive techniques including robotic-assisted approach will likely increase in the future. D-GISTs have a prognosis comparable to gastric and other small bowel GISTs. However, the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs. The use of limited resection when condition allows is recommended due to lower surgical morbidity, less postoperative complications and better oncologic outcomes.

Keywords: Duodenum, Gastrointestinal stromal tumors, Limited resection, Pancreaticoduodenectomy, Survival

Core Tip: Duodenal gastrointestinal stromal tumors are an uncommon subset of small intestinal tumors and may pose surgical challenges in curative-intent resection. I herein discuss the outcomes of current surgical resection techniques of duodenal gastrointestinal stromal tumors. A range of surgical armamentarium is therefore necessary to deal with this uniquely located duodenal gastrointestinal stromal tumor of varied sizes and degree of invasion into the surrounding structures.