Abstract:

Surgical treatment of duodenal gastrointestinal stromal tumors: A clinical analysis of multiple centers                          FENG Xing-yu*,HU Wei-xian,ZHANG Peng, et al. * Department of General Surgery, Guangdong General Hospital（Guangdong Academy of Medical Sciences）, Guangzhou 510080, China
Corresponding author：LI Yong, E-mail:yuan821007@126.com
FENG Xing-yu and HU Wei-xian are the first authors who contributed equally to the article
Abstract    Objective    To understand the clinical and pathological features of gastrointestinal stromal tumor (GIST) in duodenum and the status of surgical treatment by reviewing the data of duodenal GISTs from multi-centers in China retrospectively. Methods    The clinicopathological data of patients who received radical surgery in 13 medical centers in China from September 1998 to January 2016 were analyzed retrospectively. The data of clinical and pathological features of GIST in duodenum included preoperative and postoperative treatment as well as the effect of different surgical treatment. Results    A total of 279 cases of multi-center duodenal GISTs included 149 males (53.4%) and 130 females (46.6%) . There were 129 cases (46.2%) of the tumors located in the D2 part. The tumor size was 4.0(2.5~6.0)cm. According to the modified NIH classification criteria, there were 46 patients (16.5%) with very low risk, 90 patients (32.2%) with low risk and 113 patients (40.5%) with moderate or high risk. Besides, 30 patients (10.8%)received preoperative imatinib with no postoperative risk classification defined. A total of 232 patients (83.2%) underwent partial resection and 47 patients (16.8%) underwent pancreatoduodenectomy. The overall postoperative complication rate was 20.1%(56/279). There were 144 cases (51.6%) of traditional open surgery, and 135 cases (48.4%) with laparoscopy. The patients in partial resection group had shorter operative time, less bleeding volume, less postoperative complications, shorter postoperative hospital stay than patients in pancreatoduodenectomy group. The diameter of tumor was larger (Z=-3.229, P=0.001), and the proportion of middle and high risk patients was higher in patients with pancreatoduodenectomy than that in partial resection group. Of the 279 patients, 253 patients were followed up successfully, and the follow-up rate was 90.7%. The time of follow-up was 33.2 (1-180) months. The total 5 - year survival rate of all patients was 85.0%. There was no significant difference in the 5 year survival rate between the two groups (86.3% vs. 84.6%, P=0.548). Conclusion  Duodenal GISTs are mainly located in the D2 part of duodenum. The patients performed partial resection has better short-term effect than patients who received pancreatoduodenectomy. However, the long-term efficacy of the two groups were comparable.

Key words: gastrointestinal stromal tumor, duodenum, pancreatoduodenectomy, partial resection, laparoscope

摘要：

目的    通过回顾性分析国内多中心十二指肠胃肠间质瘤（GIST）临床数据，了解十二指肠GIST临床病理学特征及外科治疗现状。方法    回顾性分析1998年9月至2016年1月国内13家医疗中心接受根治性切除的十二指肠GIST病人的临床病理学资料，主要包括十二指肠GIST的临床病理学特征、术前术后治疗、不同手术方式治疗效果。结果    共纳入十二指肠GIST病人279例。男性149例（53.4%），女性130例（46.6%）。发病部位以十二指肠D2段最常见，共129例（46.2%），肿瘤大小为4.0（2.5~6.0）cm。根据改良NIH分级标准，极低危病人46例（16.5%），低危病人90例（32.2%），中、高危病人113例（40.5%），此外有30例（10.8%）病人接受了术前伊马替尼治疗，未进行术后危险度分级。行局限性切除术的病人共232例（83.2%），行胰十二指肠切除术者共47例（16.8%）；术后总体并发症发生率为20.1%（56/279）。行传统开放手术者144例（51.6%），行腹腔镜手术者135例（48.4%）。行局限性切除术病人在手术时间、出血量、术后并发症以及术后住院时间均优于行胰十二指肠切除病人。与行局限性切除术病人相比，行胰十二指肠切除术病人肿瘤直径较大（Z=-3.229，P＝0.001），且中、高危病人比例较高。279例病人中，253例病人成功获得随访，随访率90.7%。随访时间33.2（1～180）个月。所有病人5年总存活率为85.0%。两组病人的5年存活率差异无统计学意义（86.3% vs. 84.6%，P＝0.548）。结论  十二指肠GIST主要位于十二指肠D2段，手术方式以局限性切除术为主，局限性切除术在短期疗效方面优于胰十二指肠切除术，长期疗效两者相当。

关键词: 胃肠间质瘤, 十二指肠, 胰十二指肠切除术, 局限性切除术, 腹腔镜