Duodenal GIST: Lokasyona göre cerrahi tedavi. Literatür derlemesi ile tek merkez deneyimleri

Öz

Amaç: Gastrointestinal stromal tümörler (GIST) en yaygın sindirim yolu mezenkimal neoplazileridir, ancak GIST'lerin sadece% 1-5'i duodenumda görülür. Klinik belirtiler, yönetim, cerrahi tedavi ve bunların sonuçları tam olarak tanımlanmamıştır. Bu çalışmanın amacı, kurumumuzdaki cerrahi deneyimi ortaya koymak, duodenumdaki tümörün konumuna göre cerrahi prosedürleri analiz etmek ve anatomik olarak karmaşık olan bu bölgedeki GIST'lerin cerrahi yönetimini gözden geçirmektir.
Yöntemler: Son 5 yılda (Ocak 2014 - Aralık 2019) merkezimizde küratif amaçla cerrahi olarak tedavi edilen duodenal GIST'li hastalar bu retrospektif kohort çalışmaya dahil edildi. Demografik veriler, klinik tablo, GIST yeri, tanısal değerlendirme, onkolojik tedavi, cerrahi prosedür, mortalite ve morbidite, patolojik ve morfolojik GIST özellikleri, patolojik risk kategorisi, takip ve sağkalım not edildi.
Bulgular: Merkezimizde son 5 yılda duodenal GIST tanısı alan 5 hasta ameliyat edildi. İyileştirme amaçlı ve negatif rezeksiyon sınırları ile dört ameliyat yapıldı. Sadece biri laparoskopik yaklaşımla yapıldı. Tüm vakalarda sınırlı rezeksiyon R0 yapıldı. Hiçbir hasta ameliyattan önce neoadjuvan tedavi almadı. Tüm hastaların ortalama yaşı 63 yıldı (52-70 yıl) ve hepsi kadındı. Klinik belirtiler karın ağrısı ve üst gastrointestinal kanamadan oluşuyordu. Vakalardan biri tesadüfen teşhis edildi. Postoperatif mortalite olmadı. Ortalama hastanede kalış süresi 8 gündü (4-26 gün). Ortanca takip süresi 33 aydı (6 ay - 8 yıl). Takip sırasında 2 hasta GIST dışı nedenlerle kaybedildi ve bir hasta ilk ameliyattan 29 ay sonra rezektabl periton metastazı nedeniyle ameliyat edildi.
Sonuç: Tümör biyolojisi, duodenal GIST'nin onkolojik sonuçları için cerrahi işlemden daha önemlidir. Duodenumda görülen, cerrahi rezeksiyon endikasyonu olan GIST, karmaşık duodenum anatomisi nedeniyle cerrah için zordur.

Anahtar Kelimeler

• Gastrointestinal stromal tümör
• Duodenum
• Cerrahi işlemler

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

Abstract

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.

Keywords

• Gastrointestinal stromal tumor
• Duodenum
• Surgery procedures

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