title: Urgency surgical treatment for duodenal GISTs: analysis of aged patients and review of the literature.
abstract: BACKGROUND
  Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms (85%) of the gastrointestinal (GI) tract; duodenal GISTs constitute 3-5% of all GISTs and represent 10-30% of all malignant tumours of the duodenum. Rarely, patients present severe bowel obstruction, perforation or severe bleeding. The radical resection with complete removal of the tumour remains the main therapeutic approach. We performed a local resection in patients with suspected GIST admitted for emergency treatment for GI bleeding.
  
  
  METHODS
  We present three cases of patients admitted for GI bleeding. The cause could be a GIST bleeding. In all cases, local resection was performed without a pancreaticoduodenectomy. Histological examination on surgical preparations showed that in two cases it was a GIST and in one case, it was a leiomyoma.
  
  
  CONCLUSIONS
  Surgery remains the treatment of choice in the case of a GIST primitive without evidence of metastases, even for patients who are hospitalized for a bleeding emergency. Wide resections are not needed; it is important to remove completely the disease. In the case of duodenal GIST, it is important to get negative margins near the head of the pancreas, and this could take a PD. According to our experience and to the literature review, we believe that if the duodenal papilla or the periampullary region is not interested, you must perform a local resection. This is also because non-malignant tumours may present as GISTs and in these cases it is not recommended to run a PD.
  
  
  CONCLUSIONS
  The treatment of choice for duodenal GISTs is complete surgical resection with negative resection margins. When the papilla or the periampullary region is involved we choose to perform pancreaticoduodenectomy; otherwise it is better to perform a local resection. In fact, local resection has lower morbidity and mortality, with a comparable outcome.
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy. roberto.cirocchi@unipg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gemini
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barberini
authors.affiliation: Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Grassi
authors.affiliation: Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Avenia
authors.affiliation: Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 32400161, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena 32400161, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Tabola
authors.affiliation: Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
keywords: Bleeding; Emergency; GIST; Leiomyoma; Local resection; Pancreaticoduodenectomy