Robotic Treatment for Large Duodenal Gastrointestinal Stromal Tumor.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
25
08
2019
pubmed:
7
11
2019
medline:
29
12
2020
entrez:
8
11
2019
Statut:
ppublish
Résumé
Duodenal gastrointestinal stromal tumors (D-GISTs) represent a rare entity.1 Surgery is the primary treatment choice for localized or potentially resectable D-GISTs. The main principle is the complete excision of the lesion with microscopically negative margins, without performing lymph node dissection.2 Nevertheless, the best surgical choice is still controversial since the strategy depends not only on the tumor size but also on its anatomic location.3 A 49-year-old healthy female complained episodes of melena. Endoscopy with endoscopic ultrasound identified a 6-cm lesion of the second-third portion of the duodenum with recent bleeding, arising from muscolaris propria. A computed tomography scan confirmed a large mass suspected to be a GIST without metastases or involvement of the ampulla of Vater. On the basis of these findings, after a multidisciplinary consultation, she was offered robotic surgery with a radical intent. A duodenal-sparing da Vinci A robotic approach might be considered in cases of large D-GISTs amenable to a conservative R0 surgery. This system provides several technical advantages that facilitate otherwise complex resection and reconstruction.10.
Sections du résumé
BACKGROUND
BACKGROUND
Duodenal gastrointestinal stromal tumors (D-GISTs) represent a rare entity.1 Surgery is the primary treatment choice for localized or potentially resectable D-GISTs. The main principle is the complete excision of the lesion with microscopically negative margins, without performing lymph node dissection.2 Nevertheless, the best surgical choice is still controversial since the strategy depends not only on the tumor size but also on its anatomic location.3
METHODS
METHODS
A 49-year-old healthy female complained episodes of melena. Endoscopy with endoscopic ultrasound identified a 6-cm lesion of the second-third portion of the duodenum with recent bleeding, arising from muscolaris propria. A computed tomography scan confirmed a large mass suspected to be a GIST without metastases or involvement of the ampulla of Vater. On the basis of these findings, after a multidisciplinary consultation, she was offered robotic surgery with a radical intent.
RESULTS
RESULTS
A duodenal-sparing da Vinci
CONCLUSIONS
CONCLUSIONS
A robotic approach might be considered in cases of large D-GISTs amenable to a conservative R0 surgery. This system provides several technical advantages that facilitate otherwise complex resection and reconstruction.10.
Identifiants
pubmed: 31696397
doi: 10.1245/s10434-019-08041-z
pii: 10.1245/s10434-019-08041-z
doi:
Types de publication
Case Reports
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
1101-1102Références
Ma GL, Murphy JD, Martinez ME, Sicklick JK. Epidemiology of gastrointestinal stromal tumors in the era of histology codes: results of a population-based study. Cancer Epidemiol Biomarkers Prev. 2015;24(1):298–302.
doi: 10.1158/1055-9965.EPI-14-1002
Network NCC (2019); Guidelines soft tissue sarcoma. https://www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf . [Accessed February 4, 2019].
Lee SY, Goh BK, Sadot E, et al. Surgical strategy and outcomes in duodenal gastrointestinal stromal tumor. Ann Surg Oncol. 2017;24(1):202–210.
doi: 10.1245/s10434-016-5565-9
Lee SJ, Song KB, Lee YJ, et al. Clinicopathologic characteristics and optimal surgical treatment of duodenal gastrointestinal stromal tumor. J Gastrointest Surg. 2019;23(2):270–279.
doi: 10.1007/s11605-018-3928-1
El-Gendi A, El-Gendi S, El-Gendi M. Feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. J Gastrointest Surg. 2012;16(12):2197–2202.
doi: 10.1007/s11605-012-2034-z
Chok AY, Koh YX, Ow MY, Allen JC, Jr., Goh BK. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol. 2014;21(11):3429–3438.
doi: 10.1245/s10434-014-3788-1
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(1):170–174.
doi: 10.1007/s12029-018-00197-3
Huang Y, Chen G, Lin L, et al. Resection of GIST in the duodenum and proximal jejunum: a retrospective analysis of outcomes. Eur. J. Surg. Oncol. 2019;45(10):1950–1956.
doi: 10.1016/j.ejso.2019.05.002
Laurent M, Brahmi M, Dufresne A, et al. Adjuvant therapy with imatinib in gastrointestinal stromal tumors (GISTs)—review and perspectives. Transl Gastroenterol Hepatol. 2019;4:24.
doi: 10.21037/tgh.2019.03.07
Downs-Canner S, Van Der Vliet WJ, Thoolen SJ, et al. Robotic surgery for benign duodenal tumors. J. Gastrointest. Surg. 2015;19(2):306–312.
doi: 10.1007/s11605-014-2668-0