title: Clinical, pathological and surgical characteristics of duodenal gastrointestinal stromal tumor and their influence on survival: a multi-center study.
abstract: BACKGROUND
  The duodenum is a rare site of primary gastrointestinal stromal tumor (GIST). Overall (OS) and disease-free survival (DFS) after limited resection (LR) versus pancreaticoduodenectomy (PD) were studied.
  
  
  METHODS
  All patients who underwent surgery for primary, localized duodenal GIST between 2000 and 2011 were identified from four prospective institutional databases. OS and DFS were calculated by Kaplan-Meier method. Univariate analysis was performed.
  
  
  RESULTS
  Eighty-four patients (median follow-up 42 months) underwent LR (n = 56, 67%) or PD (n = 28, 33%). Patients in the PD group had a larger median tumor size (7 cm vs. 5 cm, p = 0.024) and higher mitotic count (39% vs. 19% >5/50 high-power fields, p = 0.05). Complications were observed in five patients (9%) in the LR group and ten patients (36%) in the PD group. OS and DFS for the entire cohort were 89% and 64% at 5 years, respectively. No difference in outcome between LR and PD were observed. Eleven patients were treated with preoperative IM. A major RECIST response was obtained in nine (80%), whereas two had stable disease. Twenty-three patients received postoperative Imatinib (IM). A trend toward a better OS in IM-treated patients could be detected only in the high-risk group.
  
  
  CONCLUSIONS
  Type of duodenal resection does not impact outcome. The choice should be determined by duodenal site of origin and tumor size. IM may be considered in cases at high risk of recurrence; in neoadjuvant setting, IM might facilitate resection and possibly increase the chance of preserving normal biliary and pancreatic anatomy.
authors: Department of Surgery, Sarcoma Service, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: C
authors: C
authors: Colombo
authors: U
authors: U
authors: Ronellenfitsch
authors: Z
authors: Z
authors: Yuxin
authors: P
authors: P
authors: Rutkowski
authors: R
authors: R
authors: Miceli
authors: E
authors: E
authors: Bylina
authors: P
authors: P
authors: Hohenberger
authors: C P
authors: CP
authors: Raut
authors: A
authors: A
authors: Gronchi
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D010879:Piperazines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011743:Pyrimidines / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate