Diagnosis and surgical treatment of duodenal gastrointestinal stromal tumor: a report of 29 patients

Objective To review our experience in the diagnosis and surgical treatment of duodenal gastrointestinal stromal tumor (GIST).Methods A retrospective study was conducted on 29 patients with duodenal GISTs diagnosed and treated in our hospital between May 1999 and March 2013.Results The clinical symptoms included melaena,and upper abdominal discomfort or pain.The preoperative diagnosis depended on imaging and endoscopy,but tumour biopsy had a low accuracy.Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) helped to confirm the diagnosis in some patients.All these patients received curative surgical resection successfully.The operations included 13 pancreaticoduodenectomy,11 local duodenal resections and 5 segmental duodenectomy.Imatinib was given to 7 patients postoperatively.At a mean follow-up of 48.2 months (range 2-118),23 patients were alive with no evidence of recurrence or metastasis.Four patients had developed liver metastasis,and two patients had developed tumor recurrence.A Mitotic count ≥5/50 high-power field (HPF) was a risk factor of post-operative recurrence and metastasis.Conclusions Surgical resection is the best treatment for duodenal GIST.The optimal surgery depends on the tumor size and location.Early diagnosis and complete tumor resection are important for a good prognosis.Patients with tumor rupture or high risk grading should be given imatinib therapy postoperatively. Key words: Duodenal neoplasm;  Gastrointestinal stromal tumors;  Diagnosis;  Surgical treatment