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Syed AS, Vaughan AR, McCarthy JG, Laczek JT. Bleeding Gastrointestinal Stromal Tumor (GIST) Results in a Sticky Situation: The Good and Bad of Hemostatic Spray. Cureus 2023; 15:e46691. [PMID: 37942371 PMCID: PMC10629834 DOI: 10.7759/cureus.46691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
A 50-year-old female presented with symptomatic anemia and hematemesis due to a 3.3 cm gastric gastrointestinal stromal tumor (GIST), which was located in the fundus. Adequate endoscopic views were only achieved in the retroflexed position and attempts at hemostasis via endoscopic clips were unsuccessful. Subsequently, TC-325 hemostatic powder was sprayed on the bleeding lesion and given retroflexed positioning, the powder also coated the esophagogastroduodenoscopy (EGD) scope where it abutted the gastroesophageal junction (GEJ). Hemostasis was successful, but the scope was unable to be withdrawn due to adherence to the surrounding mucosa. With torque maneuvering and a moderate amount of withdrawal force, the scope was successfully freed. The patient was started on imatinib mesylate and did not experience further bleeding episodes. This case highlights the challenge of achieving hemostasis in a bleeding GIST, the beneficial role of hemostatic powder spray, and the need for caution when utilizing it in a retroflexed manner.
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Affiliation(s)
- Azfar S Syed
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
| | | | - John G McCarthy
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jeffrey T Laczek
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
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Hu D, Duan Y, Chen Y, Li B, Du Y, Shi S. A case report of gastrointestinal stromal tumor of the duodenum. Am J Transl Res 2022; 14:8279-8285. [PMID: 36505329 PMCID: PMC9730101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) rarely occur in the duodenum, and only a few cases have been reported. Its clinical manifestations are not specific, and the imaging examination results are not typical, so a preoperative diagnosis is difficult. Pathologic examinations and genetic testing after surgical resection are the main diagnostic methods. Here, a case of duodenal stromal tumor complicated by gastrointestinal perforation is reported. A 57-year-old man presented with paroxysmal abdominal pain and bloating for 7 days. Contrast-enhanced computed tomography of the abdomen revealed a large mass (10 cm in diameter) in the right upper abdomen, which was considered neoplastic. The mass was anterior and inferior to the head of the pancreas, and medial to the mesenteric vessels. The tumor surrounded the descending and horizontal parts of the duodenum, and it ruptured into the lumen of the descending duodenum. After the patient underwent tumor resection, we found a rupture of the descending duodenal opening. After that, duodenal fistula drainage, gastrostomy, jejunostomy, small intestinal adhesion release and abdominal irrigation drainage were performed. Immunohistochemical staining results were as follows: CD34 (-), desmin (-), S-100 (-), CD117 (9.7) (+), DoG-1 (+), SDHB (+), Ki-67 (+5%). Based on these results, the lesion was finally diagnosed as duodenal GIST. The patient underwent surgical resection without targeted therapy and recovered well. DISCUSSION Duodenal stromal tumors often present with gastrointestinal bleeding and other clinical symptoms, requiring urgent surgery. Complete resection of the tumor is an effective surgical method. Extended resection does not prolong survival. However, surgical treatment should be determined according to the size and location of the tumor and its relationship to the pancreas. This highly malignant duodenal stromal tumor was >10 cm, accompanied by gastrointestinal perforation and necrosis. Surgical resection was required while protecting the organ function.
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Affiliation(s)
- Danqiong Hu
- Department of Gastroenterology, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
| | - Yangri Duan
- Department of Gastroenterology, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
| | - Yonghua Chen
- Department of Emergency, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
| | - Bingfeng Li
- Department of General Surgery, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
| | - Yechun Du
- Department of Gastroenterology, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
| | - Shuimei Shi
- Department of Internal Medicine-Cardiovascular, The Third People’s Hospital of Yuhang DistrictHangzhou 311100, Zhejiang, China
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Schlanger D, Popa C, Ciocan A, Șofron C, Al Hajjar N. Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series. J Clin Med 2022; 11:jcm11102891. [PMID: 35629017 PMCID: PMC9143146 DOI: 10.3390/jcm11102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival.
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Affiliation(s)
- Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-074-357-8432
| | - Andra Ciocan
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Cornelia Șofron
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
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Lee S, Kwon J, Lee J. Laparoscopic treatment of gastrointestinal stromal tumors located at the duodenojejunal junction. SAGE Open Med Case Rep 2020; 8:2050313X20934688. [PMID: 32655866 PMCID: PMC7333481 DOI: 10.1177/2050313x20934688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
Gastrointestinal stromal tumors are the most common subepithelial tumors of the gastrointestinal tract. Gastrointestinal stromal tumors are commonly detected in the stomach followed by the small intestine. Surgery for gastrointestinal stromal tumors affecting the duodenojejunal junction is technically challenging because of the anatomical complexity of this area. A 56-year-old woman visited the outpatient clinic with the chief complaint of melena associated with dizziness from 5 days ago. Abdominal computed tomography revealed an enhancing small bowel mass measuring 4 cm × 5 cm in the left upper abdomen abutting the duodenojejunal junction. She underwent successful laparoscopic small bowel segmental resection of the duodenojejunal junction area. Laparoscopic segmental resection with side-to-side duodenojejunostomy for a gastrointestinal stromal tumor at the duodenojejunal junction is an advanced and challenging procedure requiring experience and a good surgical technique.
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Affiliation(s)
- Seokyoun Lee
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Jungnam Kwon
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Junhee Lee
- Department of Emergency Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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Tirotta F, Fumagalli E, Colombo C, Morosi C, Barisella M, Radaelli S, Frezza AM, Casali PG, Gronchi A, Fiore M. Management of complicated tumor response to tyrosine-kinase inhibitors in gastrointestinal stromal tumors. J Surg Oncol 2019; 120:256-261. [PMID: 31066052 DOI: 10.1002/jso.25491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim was to describe complicated tumor response (CTR) to tyrosine-kinase inhibitors (TKI) in gastrointestinal stromal tumors (GIST) patients. METHODS From 2001 to 2017, data from patients with metastatic (group A) or locally advanced (group B) GIST who received TKI at our institution were collected. We defined CTR as bleeding, abscess, or perforation as surgical complications of TKI. Patients who had progressive disease were excluded. Clinical characteristics were assessed, and time of occurrence and mortality rate recorded. RESULTS Among 470 patients, 30 developed CTR (6.4%), 26 in group A (6.8%) and four in group B (4.5%) (P = 0.43). Bleeding, abscess, and perforation, respectively, were observed in 17 (56.7%), 8 (26.7%), and 5 (16.7%) patients. A conservative approach was possible in 17 (56.7%) cases; four (13.3%) patients received percutaneous drainage, while nine (30%) underwent emergency surgery. The overall rate of mortality was 13.3%. CTR occurred after 1.6 months (median time) from the imatinib mesylate onset in group B and 14 months in group A. CONCLUSIONS While the risk of CTR in early metastatic patients is virtually nil, patients with locally advanced disease should be monitored carefully. CTR as a consequence of TKI therapy do not prevent patients receiving a potentially curative surgery.
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Affiliation(s)
- Fabio Tirotta
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Fumagalli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna M Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Krishnamurthy G, Singh H, Sharma V, Savlania A, Vasishta RK. Therapeutic Challenges in the Management of Bleeding Duodenal Gastrointestinal Stromal Tumor: a Case Report and Review of Literature. J Gastrointest Cancer 2019; 50:170-174. [PMID: 30628032 DOI: 10.1007/s12029-018-00197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Jakob J, Hohenberger P. Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors. Visc Med 2018; 34:359-365. [PMID: 30498703 PMCID: PMC6257203 DOI: 10.1159/000493405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are rare malignant tumors in terms of incidence, and they are not linked to specific symptoms. Often, primary tumors, particularly of the stomach, rectum, or rectovaginal space, are quite large when detected, and multivisceral resection seems to be the treatment of choice as the mainstay of therapy is complete tumor removal. If a gain-of-function mutation in the KIT gene is present, drug therapy with receptor tyrosine kinase inhibitors (RTKIs) might significantly downstage primary GIST tumors. METHODS A review of the literature was performed to identify the current evidence for preoperative treatment of GIST regarding toxicity, efficacy, and oncological outcome, including mutational data from our own database. RESULTS Four phase II as well as several cohort studies showed acceptable toxicity and no increased perioperative morbidity of preoperative imatinib. Progressive disease during preoperative treatment was a rare event, and partial response was achieved in 40-80% of all patients. For methodological reasons, the trials cannot prove an oncological long-term superiority of preoperative treatment. CONCLUSION Preoperative therapy with imatinib is safe and recommended for patients with locally advanced GIST. Neoadjuvant imatinib therapy may enable less invasive and organ-sparing surgery, avoid tumor rupture during extensive resectional procedures, and improve the quality of perioperative RTKI treatment.
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Affiliation(s)
- Jens Jakob
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
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Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
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Liu Z, Zheng G, Liu J, Liu S, Xu G, Wang Q, Guo M, Lian X, Zhang H, Feng F. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: a series of 300 patients. BMC Cancer 2018; 18:563. [PMID: 29764388 PMCID: PMC5952823 DOI: 10.1186/s12885-018-4485-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/08/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor still under debate. Thus, this study aimed to explore the optimal surgical strategy and prognosis of duodenal GISTs. METHODS A total of 300 cases of duodenal GISTs were obtained from our center (37 cases) and from case reports or series (263 cases) extracted from MEDLINE. Clinicopathological features, type of resections and survivals of duodenal GISTs were analyzed. RESULTS The most common location of duodenal GISTs was descending portion (137/266, 51.5%). The median tumor size was 4 cm (0.1-28). Most patients (66.3%) received limited resection (LR). Pancreaticoduodenectomy (PD) was mainly performed for GISTs with larger tumor size or arose from descending portion (both P < 0.05). For both the entire cohort and tumors located in the descending portion, PD was not an independent risk factor for disease-free survival (DFS) and disease-specific survival (DSS) (both P > 0.05). Duodenal GISTs were significantly different from gastric GISTs with respect to tumor size, mitotic index and NIH risk category (all P < 0.05). The DFS and DSS of duodenal GISTs was significantly worse than that of gastric GISTs (both P < 0.05). CONCLUSIONS LR was a more prevalent surgical procedure and PD was mainly performed for tumors with larger diameter or located in descending portion. Type of resection was not an independent risk factor for the prognosis of duodenal GISTs. Prognosis of duodenal GISTs was significantly worse than that of gastric GISTs.
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Affiliation(s)
- Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No.1 Hospital of PLA, 74 Jingning Road, Lanzhou, 730030 China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Jinqiang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Cadre’ s sanitarium, 62101 Army of PLA, 67 Nahu Road, Xinyang, 464000 Henan China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, 454000 Henan China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
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Yamamoto Y, Sasaki Y, Kougame M, Tochigi N. Giant oesophageal gastrointestinal stromal tumour presenting with dyspnoea and clubbed fingers. BMJ Case Rep 2017; 2017:bcr-2017-220540. [PMID: 28751509 PMCID: PMC5623222 DOI: 10.1136/bcr-2017-220540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms of the gastrointestinal tract originating from the interstitial cells of Cajal. Giant oesophageal GISTs are rare since the oesophagus is rarely the primary site of GISTs, and they are usually diagnosed early due to complaints such as dysphagia. We present the case of a giant oesophageal GIST presenting with prominent clubbing. The case underlined the diagnostic importance of clubbing and the careful consideration of chemotherapy. Although clubbed fingers associated with GISTs are rare, our experience demonstrates the importance of physicians’ recognition of clubbing as a paraneoplastic phenomenon for early diagnosis of malignancies since patients seldom notice their own clubbing by themselves. Chemotherapy using imatinib, an Bcr-Abl kinase inhibitor, is the standard option for unresectable giant GISTs. However, careful consideration must be made of the risk of complications associated with rapid mass reduction due to imatinib such as bleeding, oesophageal perforation and mediastinitis.
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Affiliation(s)
- Yurie Yamamoto
- Department of Gastroenterology, Toho University Medical Center Omori Hospital, Ota-ku, Tokyo, Japan
| | - Yosuke Sasaki
- Department of General Medicine and Emergency Care, Toho Universtiy, School of Medicine, Ota-ku, Tokyo, Japan
| | - Michio Kougame
- Department of Gastroenterology, Toho University Medical Center Omori Hospital, Ota-ku, Tokyo, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University Medical Center Omori Hospital, Ota-ku, Tokyo, Japan
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Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery. Gastroenterol Res Pract 2017; 2017:2036951. [PMID: 28757865 PMCID: PMC5512028 DOI: 10.1155/2017/2036951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/01/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. METHODS From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34-82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57-70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. RESULTS All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14-23). CONCLUSION Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.
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Tsai CY, Lai BR, Wang SY, Liao CH, Liu YY, Kang SC, Yeh CN, Jan YY, Yeh TS. The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients. World J Emerg Surg 2017; 12:21. [PMID: 28469698 PMCID: PMC5414322 DOI: 10.1186/s13017-017-0133-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/25/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Emergent pancreaticoduodenectomy is a life-saving procedure in certain clinical scenarios when all the conservative treatment fails. The indications can be limited into perforation and bleeding. To clarify the impact of etiology on surgical outcomes of emergent pancreaticoduodenectomy for non-trauma, we analyzed our patients and performed a literature review. METHODS We reviewed 931 consecutive pancreaticoduodenectomies performed at our institute between January 2001 and July 2015. Patients with emergent pancreaticoduodenectomy for non-trauma etiologies were enrolled, whereas those who suffered from caustic injuries were excluded. The keywords "emergent/emergency" and "pancreaticoduodenectomy/pancreatoduodenectomy" were applied in a literature search. The universally available data for all the enrolled patients including etiology, surgical complications, outcomes, and hospital stays were analyzed. Univariate and multivariate logistic analysis for the contributing factors to surgical mortality were performed. RESULTS Six out of 931 (0.6%) registered pancreaticoduodenectomies matched our criteria of inclusion. The literature review obtained 4 series and 7 case reports, which when combined with our patients yielded a cohort of 31 emergent pancreaticoduodenectomies with 13 cases of perforation and 18 of bleeding. The rate of emergent pancreaticoduodenectomy for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%. The overall surgical complication rate was 83.9%. The rate of surgical mortality is significantly higher than in elective pancreaticoduodenectomy by propensity score matching with age and gender (19.4 versus 3.2%, P = 0.015). Univariate and multivariate logistic regression disclosed that etiology is the only preoperative risk factor for surgical mortality (perforation versus bleeding; odds ratio = 39.494, P = 0.031). CONCLUSIONS Emergent pancreaticoduodenectomy remains a rare operation. Surgical morbidity and mortality are higher than with elective pancreaticoduodenectomy among different reported series. By sorting the preoperative etiologies into two groups, perforation carries a higher risk of surgical mortality than bleeding.
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Affiliation(s)
- Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Bo-Ru Lai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Shang-Yu Wang
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Chien-Hung Liao
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Yu-Yin Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Shih-Ching Kang
- Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan.,Department of Traumatology and Emergent Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou branch, No.5, Fu-Xing Street, Kueishan District, Taoyuan City, 333 Taiwan.,Chang Gung University, No. 259, Wen Hua First Road, Kueishan District, Taoyuan City, 333 Taiwan
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14
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Suh BJ. A Case of Malignant Gastrointestinal Stromal Tumor Initially Misdiagnosed as Malignant B-Cell Lymphoma. Case Rep Oncol 2016; 9:344-50. [PMID: 27462236 PMCID: PMC4939670 DOI: 10.1159/000447352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 11/19/2022] Open
Abstract
Errors that occur in anatomic pathology influence the treatment strategy of patients with malignancy. There are four general types of error with three subtypes in the category of defective interpretation. The first subtype is a false-negative diagnosis or undercall of the extent or severity of the lesion, the second is a false-positive diagnosis, and the third is misclassification. We herein report a 65-year-old female patient with malignant gastrointestinal stromal tumor that was diagnosed after reevaluation of the lesion at our hospital – and treated with proximal gastrectomy – after initial diagnosis as malignant B-cell lymphoma on esophagogastroduodenoscopy biopsy of a small gastric fundic mass and subsequent treatment with six cycles of CHOP chemotherapy with aggravation of the mass at another hospital.
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Affiliation(s)
- Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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15
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Miyake KK, Nakamoto Y, Mikami Y, Tanaka S, Higashi T, Tadamura E, Saga T, Minami S, Togashi K. The predictive value of preoperative 18F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour. Eur Radiol 2016; 26:4664-4674. [PMID: 26852217 DOI: 10.1007/s00330-016-4242-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the potential value of preoperative 18F-FDG PET to predict postoperative recurrence of solitary localized primary gastrointestinal stromal tumour (GIST) after radical resection. METHODS A total of 46 patients with primary GIST who received preoperative 18F-FDG PET and underwent complete resection without neoadjuvant therapy were retrospectively studied. PET findings, including ring-shaped uptake and intense uptake, were compared with Joensuu risk grades using Fisher's exact test. The prognostic value of the preoperative clinico-imaging variables-age ≥60 years, male, ring-shaped uptake, intense uptake, tumour size >5 cm, heterogeneous CT attenuation and lower gastrointestinal origin-and Joensuu high risk for recurrence-free survival was evaluated using log-rank test and multivariate Cox regression analysis. RESULTS Ring-shaped uptake and intense uptake were significantly associated with Joensuu high risk. Univariate analysis showed that ring-shaped uptake, intense uptake, size >5 cm and Joensuu high risk were significantly associated with inferior recurrence-free survival. Multivariate analysis showed that ring-shaped uptake (P = 0.004) and Joensuu high risk (P = 0.021) were independent adverse prognostic factors of postoperative recurrence. CONCLUSIONS Ring-shaped uptake on preoperative 18F-FDG PET may be a potential predictor of postoperative tumour recurrence of localized primary GISTs. KEY POINTS • Clinical course of resectable solitary localized primary GISTs varies widely. • Ring-shaped uptake is an independent adverse prognostic factor of postoperative recurrence. • Preoperative 18 F-FDG PET may help predict postoperative recurrence of GISTs.
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Affiliation(s)
- Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan.
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.,Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | | | - Eiji Tadamura
- Department of Radiology, Sakazaki Clinic, Kyoto, Japan
| | - Tsuneo Saga
- Dianostic Imaging Group, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Shunsuke Minami
- Department of Radiology, Shiga Medical Center for Adults, Shiga, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
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16
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Zioni T, Dizengof V, Kirshtein B. Laparoscopic resection of duodenal gastrointestinal stromal tumour. J Minim Access Surg 2016; 13:157-160. [PMID: 28281485 PMCID: PMC5363127 DOI: 10.4103/0972-9941.195576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Only a few studies have revealed using laparoscopic technique with limited resection of gastrointestinal stromal tumour (GIST) of the duodenum. A 68-year-old man was admitted to the hospital due to upper gastrointestinal (GI) bleeding. Evaluation revealed an ulcerated, bleeding GI tumour in the second part of the duodenum. After control of bleeding during gastroduodenoscopy, he underwent a laparoscopic wedge resection of the area. During 1.5 years of follow-up, the patient is disease free, eats drinks well, and has regained weight. Surgical resection of duodenal GIST with free margins is the main treatment of this tumour. Various surgical treatment options have been reported. Laparoscopic resection of duodenal GIST is an advanced and challenging procedure requiring experience and good surgical technique. The laparoscopic limited resection of duodenal GIST is feasible and safe, reducing postoperative morbidity without compromising oncologic results.
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Affiliation(s)
- Tammy Zioni
- Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Vitaliy Dizengof
- Department of Gastroenterology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Boris Kirshtein
- Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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17
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Muñoz E, Pardo-Aranda F, Puértolas N, Larrañaga I, Camps J, Veloso E. Management of a Gastrobronchial Fistula Connected to the Skin in a Giant Extragastric Stromal Tumor. Case Rep Surg 2015; 2015:204729. [PMID: 26290765 PMCID: PMC4531185 DOI: 10.1155/2015/204729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/28/2015] [Accepted: 07/12/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Gastrointestinal stromal tumors first treatment should be surgical resection, but when metastases are diagnosed or the tumor is unresectable, imatinib must be the first option. This treatment could induce some serious complications difficult to resolve. Case Report. We present a 47-year-old black man with a giant unresectable gastric stromal tumor under imatinib therapy who presented serious complications such as massive gastrointestinal bleeding and a gastrobronchial fistula connected with the skin, successfully treated by surgery and gastroscopy. Discussion. Complications due to imatinib therapy can result in life threatening. They represent a challenge for surgeons and digestologists; creative strategies are needed in order to resolve them.
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Affiliation(s)
- Emilio Muñoz
- Hospital Universitari Mutua Terrassa, 08221 Barcelona, Spain
| | | | | | | | - Judith Camps
- Hospital Universitari Mutua Terrassa, 08221 Barcelona, Spain
| | - Enrique Veloso
- Hospital Universitari Mutua Terrassa, 08221 Barcelona, Spain
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18
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Marano L, Boccardi V, Marrelli D, Roviello F. Duodenal gastrointestinal stromal tumor: From clinicopathological features to surgical outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:814-22. [PMID: 25956211 DOI: 10.1016/j.ejso.2015.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/01/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
Abstract
Duodenal gastrointestinal tumors represent an extremely rare subset of stromal tumors arising from interstitial cells of Cajal. In the last 30 years the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity, in association with developments in endoscopy, imaging technology, and immunohistochemistry has resulted in novel diagnostic and treatment approaches. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and treatment of these tumors. The duodenum is the less commonly involved site for these tumors in the digestive tract. Endoscopy and computed tomography can usually establish the diagnosis, confirmed by immunohistochemical staining and occasionally molecular genetic analysis. Endoscopic ultrasound with fine needle aspiration has been recently found to be the gold diagnostic standard with high sensitivity and specificity rates, diagnosing GIST in up to 80% of patients. Due to the complex anatomy of the pancreatico-duodenal region optimal therapeutic strategy of duodenal GISTs are challenging. Nevertheless surgical resection with microscopically clear resection margins seems to be the only potentially curative treatment for non-metastatic primary GISTs of the duodenum. Imatinib mesylate plays a key role in the management of GISTs both as neoadjuvant therapy and in patients with recurrent and metastatic disease. Meanwhile, the advances in the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity as well as the treatment of these tumors may render feasible, in the near future, the advent of newer and more effective treatment options.
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Affiliation(s)
- L Marano
- Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
| | - V Boccardi
- Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - D Marrelli
- Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
| | - F Roviello
- Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy
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19
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Lissidini G, Prete FP, Piccinni G, Gurrado A, Giungato S, Prete F, Testini M. Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review. Int J Surg 2015; 21 Suppl 1:S83-8. [PMID: 26130436 DOI: 10.1016/j.ijsu.2015.04.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/27/2015] [Accepted: 04/10/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Emergency pancreaticoduodenectomy (EPD) has been very rarely reported in literature as a lifesaving procedure for complex pancreatic injury, uncontrollable hemorrhage from ulcers and tumors, descending duodenal perforations, and severe infection. The aim of this study was to analyze the experience of two non-trauma centers and to review the literature concerning emergency pancreaticoduodenectomy. METHODS From January 2005 to December 2014, from a population of 169 PD (92 females and 77 males; mean age: 61.3, range 23-81) 5 patients (3%; 2 females and 3 males; mean age: 57.8, range: 42-74) underwent EPD for non-traumatic disease performed at two Academic Units of the University of Bari. RESULTS The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity of 80%, and mortality of 40%. In 80% (4/5) of patients treated by emergency pancreaticoduodenectomy, the pancreatic remnant was not reconstructed, and in 20% (1/5) a pancreaticojejunostomy was performed. CONCLUSION Emergency pancreaticoduodenectomy is an effective life-saving operation reservable to pancreatoduodenal trauma, perforations, and bleeding, unmanageable by a less invasive approach. It should be preferentially approached by surgeons with a high level of experience in hepatobiliary and pancreatic surgery and in trauma centers too, but it should also be in the armamentarium of general surgeons performing hepato-pancreato-biliary surgery.
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Affiliation(s)
- Germana Lissidini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Francesco Paolo Prete
- Unit of Videolaparoscopic Surgery, Department of Emergency Surgery and Organs Transplantation, University of Bari, Italy.
| | - Giuseppe Piccinni
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Angela Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | - Simone Giungato
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
| | | | - Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Italy.
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20
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Viswanathan C, Truong M, Sagebiel T, Garg N, Bhosale P. Imaging of Chemotherapy-related Iatrogenic Abdominal and Pelvic Conditions. Radiol Clin North Am 2014; 52:1029-40. [DOI: 10.1016/j.rcl.2014.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Viswanathan C, Truong MT, Sagebiel TL, Bronstein Y, Vikram R, Patnana M, Silverman PM, Bhosale PR. Abdominal and Pelvic Complications of Nonoperative Oncologic Therapy. Radiographics 2014; 34:941-61. [DOI: 10.1148/rg.344140082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Cappellani A, Piccolo G, Cardì F, Cavallaro A, Lo Menzo E, Cavallaro V, Zanghì A, Di Vita M, Berretta M. Giant gastrointestinal stromal tumor (GIST) of the stomach cause of high bowel obstruction: surgical management. World J Surg Oncol 2013; 11:172. [PMID: 23914945 PMCID: PMC3737110 DOI: 10.1186/1477-7819-11-172] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/30/2013] [Indexed: 02/07/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) represent 85% of all mesenchymal neoplasms that affect the gastrointestinal (GI) tract. These GISTs range in size from small lesions to large masses. Often they are clinically silent until they reach a significant size, so their discovery is usually incidental. Case presentation A 67-year-old man was admitted at our general surgery department with a persistent abdominal pain in the left hypochondrium, associated with nausea and vomiting. Clinical examination revealed a palpable mass in the epigastrium and in the left hypochondrium, which was approximately 40 cm long. Ultrasonography and computed tomography of the abdomen showed a large mass of 40 × 25 cm, which extended from the posterior wall of the stomach to the spleen, involving the body and the tail of the pancreas. The patient underwent en-block resection of the mass, sleeve resection of the stomach, and distal pancreatectomy-splenectomy. The histopathology of the resected specimen was consistent with a gastrointestinal stromal tumor of the stomach (positive for CD 117) with a high risk of malignancy (mitotic count >5/50 high-power fieldand Ki67/Mib1 >10%). The postoperative course was uneventful and treatment with imatinib mesylate began immediately. The patient appears to be disease free after four years. Conclusions Giant GISTs of the stomach are rare. Surgical resection with curative intent is feasible. The combination of surgical resection and imatinib can provide long-termdisease-free survival. An R0 resection is the best achievable treatment, therefore the patient should be evaluated over time for potential resectability.
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23
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Mouaqit O, Chbani L, Maazaz K, Amarti A, Ait Taleb K, Oussaden A. A large gastrointestinal stromal tumor of the duodenum treated by partial duodenectomy with Roux-en-Y duodenojejunostomy: a case report. J Med Case Rep 2013; 7:184. [PMID: 23856455 PMCID: PMC3726472 DOI: 10.1186/1752-1947-7-184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 05/31/2013] [Indexed: 01/19/2023] Open
Abstract
Introduction Duodenal gastrointestinal stromal tumors are uncommon and a relatively small subset of gastrointestinal stromal tumors whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement are infrequent in gastrointestinal stromal tumors, wide margins with routine lymph node dissection may not be required. Various surgical procedures for duodenal gastrointestinal stromal tumor, pancreatoduodenectomy, pancreas-sparing duodenectomy, segmental duodenectomy, or local resection, have been described depending on the size and exact site of the lesion. Case presentation We present the case of a 65-year-old African woman with a giant gastrointestinal stromal tumor involving the second and third portion of the duodenum successfully treated by partial duodenectomy with duodenojejunostomy. This surgical technique is ideal when a gastrointestinal stromal tumor does not involve the ampulla because it avoids a pancreatoduodenectomy, and has not been previously described for the management of this malignancy. Duodenal gastrointestinal stromal tumor should be suspected in any patient with a duodenal wall mass. Conclusions Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis.
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Affiliation(s)
- Ouadii Mouaqit
- Surgery Department, University Hospital Hassan II, Fez, Morocco.
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24
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Arango Tomás E, Algar Algar FJ, Salvatierra Velázquez A. [Subcarinal gastrointerstinal stromal tumor]. Cir Esp 2013; 91:677-8. [PMID: 23332651 DOI: 10.1016/j.ciresp.2012.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Elisabet Arango Tomás
- Unidad de Gestión Clínica Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Reina Sofía, Córdoba, España.
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25
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26
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Saad Aldin E, Mourad F, Tfayli A. Gastric antral vascular ectasia in a patient with GIST after treatment with imatinib: case report and literature review. Jpn J Clin Oncol 2012; 42:447-50. [PMID: 22422898 DOI: 10.1093/jjco/hys032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Imatinib mesylate is a receptor kinase inhibitor approved by the Food and Drug Administration for the treatment of malignant metastatic and/or unresectable gastrointestinal stromal tumors and chronic myelogenous leukemia. Although imatinib is generally well tolerated, certain adverse drug reactions are common. These include gastrointestinal side-effects such as diarrhea, nausea and vomiting, as well as hematological side-effects and other miscellaneous side-effects such as fatigue, edema, dermatitis and dyspnea. We present a previously unreported adverse effect of imatinib, gastric antral vascular ectasia, in a 74-year-old woman with gastrointestinal stromal tumor in remission treated with adjuvant imatinib. Endoscopy performed prior to starting imatinib showed normal gastric mucosa, but 8 months after starting imatinib showed diffuse gastric inflammation. Repeat endoscopy 1 month after discontinuing imatinib showed significant improvement in gastric inflammation.
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Affiliation(s)
- Ehab Saad Aldin
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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27
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Caram MV, Schuetze SM. Advanced or metastatic gastrointestinal stromal tumors: systemic treatment options. J Surg Oncol 2011; 104:888-95. [PMID: 22069173 DOI: 10.1002/jso.21930] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gastrointestinal stromal tumor (GIST), the most common sarcoma arising in the gastrointestinal tract, typically expresses the tyrosine-kinase receptor, C-KIT, and contains activating mutation in the c-kit or platelet-derived growth factor receptor (pdgfr) gene. Recently, development of small molecules that inhibit the kinase activity of mutant C-KIT and PDGFR proteins has radically changed treatment and prognosis of patients diagnosed with advanced GIST as this molecularly "targeted" therapy has demonstrated remarkable high-level of activity in this disease.
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Affiliation(s)
- Megan V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Michigan, USA
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