Duodenal GIST: Surgical treatment based on the location. A single center experience with review of the literature

Aim: Gastrointestinal stromal tumors (GIST) are the most common digestive tract mesenchymal neoplasms, but only 1 to 5% of GISTs occur in the duodenum. Consequently, clinical manifestations, management and surgical treatment and their results remain poorly defined. The aim of this study is to expose the surgical experience in our institution, analyze surgical procedures according to the location of the tumor in the duodenum, and review the surgical management of GISTs in this anatomically complex region. Methods: Patients with duodenal GISTs who were surgically treated with curative intention in our center during the last 5 years (January 2014 - December 2019) were included in this retrospective cohort study. Demographic data, clinical presentation, GIST location, diagnostic evaluation, oncologic treatment, surgical procedure, mortality and morbidity, pathological and morphological GIST characteristics, pathological risk category, follow up and survival were noted. Results: Five patients diagnosed with duodenal GIST were operated in our center during the last 5 years. Four surgeries were performed with intent to cure and negative margins of resection. Only one was performed by laparoscopic approach. Limited resection R0 was done in all cases. None of the patients received neoadjuvant treatment before surgery. All patients were women with a mean age of 63 years (52-70 years). Clinical manifestations consisted of abdominal pain and upper gastrointestinal bleeding. One of the cases was incidentally diagnosed. There was no postoperative mortality. Mean length of stay was of 8 days (4-26 days). The median follow-up time was 33 months (6 months - 8 years). During the follow up, 2 patients passed away due non-GIST related causes, and one patient was operated for resectable peritoneum metastasis 29 months after the initial surgery. Conclusion: Tumor biology is more important than the surgical procedure for oncologic results of duodenal GIST. GIST located in duodenum with surgical indication is a challenge for the surgeon due to the complex duodenum anatomy.