title: Conservative surgery vs. duodeneopancreatectomy in primary duodenal gastrointestinal stromal tumors (GIST): a retrospective review of 114 patients from the French sarcoma group (FSG).
abstract: BACKGROUND
  Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs.
  
  
  METHODS
  Patients were identified via a survey from 16 FSG centers (n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation.
  
  
  RESULTS
  114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were R0 (n = 87, 79%), R1 (n = 8, 7%), R2 (n = 6). Tumor characteristics were: KIT+ (n = 104), CD34+ (n = 58). Miettinen risk was low (n = 43), and high (n = 52). Imatinib was administered preoperatively (n = 11) and post-operatively (n = 20). With a median follow-up of 36 months (2-250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups (P > 0.05). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse.
  
  
  CONCLUSIONS
  Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD.
authors.affiliation: Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France. Electronic address: fduffaud@mail.ap-hm.fr.
authors.forename: F
authors.initials: F
authors.lastname: Duffaud
authors.affiliation: Service de Chirurgie, Centre Léon Bérard, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Meeus
authors.affiliation: Service d'Hépato-gastroentérologie, CHU Pitié Salpétrière, Paris, France.
authors.forename: J B
authors.initials: JB
authors.lastname: Bachet
authors.affiliation: Service d'Oncologie Médicale, Centre Léon Bérard, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Cassier
authors.affiliation: Service d'Oncologie Médicale, CHU Timone, AP-HM, Marseille, and Aix-Marseille Université (AMU), Marseille, France.
authors.forename: T K
authors.initials: TK
authors.lastname: Huynh
authors.affiliation: Service d'Oncologie médicale, Centre Eugène Marquis, Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Boucher
authors.affiliation: Service d'Oncologie digestive, CHU de Reims, France.
authors.forename: O
authors.initials: O
authors.lastname: Bouché
authors.affiliation: Service de Chirurgie digestive, CHU Nord, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Moutardier
authors.affiliation: Service d'Oncologie médicale, Institut Gustave Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: le Cesne
authors.affiliation: Service de Gastro-entérologie et Oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Landi
authors.affiliation: Département de Chirurgie, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Marchal
authors.affiliation: Service d'oncologie médicale, CHU Clermont Ferrand, France.
authors.forename: J O
authors.initials: JO
authors.lastname: Bay
authors.affiliation: Service d'Oncologie médicale, Institut Paoli Calmettes, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Bertucci
authors.affiliation: Service d'Oncologie médicale, CHU Pitié Salpétrière, Paris, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Spano
authors.affiliation: Service d'Oncologie médicale, Institut Bergonié, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Service d'Oncologie Médicale, CLCC, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France.
authors.forename: O
authors.initials: O
authors.lastname: Collard
authors.affiliation: Service d'oncologie médicale, CHU de Besançon, France.
authors.forename: L
authors.initials: L
authors.lastname: Chaigneau
authors.affiliation: Oncologie médicale, Centre G Leclerc, Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Isambert
authors.affiliation: Service d'Oncologie médicale, CHU Dijon, France.
authors.forename: V
authors.initials: V
authors.lastname: Lebrun-Ly
authors.affiliation: Service de Santé Publique et d'Information Médicale, Unité de Biostatistiques, CHU Timone, Marseille, and Aix-Marseille Université (AMU), France.
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Service d'Oncologie Médicale, Centre Léon Bérard, Lyon, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Service de Chirurgie, Institut G Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonvalot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005602:France; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Duodenal GIST; Imatinib therapy; Local resection; Pancreaticoduodenectomy