Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study.
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:
Oct 2021
Oct 2021
Historique:
received:
12
11
2020
accepted:
26
02
2021
pubmed:
12
4
2021
medline:
28
9
2021
entrez:
11
4
2021
Statut:
ppublish
Résumé
The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate.
OBJECTIVES
OBJECTIVE
The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN).
METHODS
METHODS
In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated.
RESULTS
RESULTS
Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences.
CONCLUSIONS
CONCLUSIONS
For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
Identifiants
pubmed: 33839975
doi: 10.1245/s10434-021-09862-7
pii: 10.1245/s10434-021-09862-7
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
6294-6306Investigateurs
Francois Browet
(F)
Charles Sabbagh
(C)
Jean-Marc Regimbeau
(JM)
Emilie Lermite
(E)
Antoine Hamy
(A)
Kevin Kraft
(K)
Richard Douard
(R)
Philippe Wind
(P)
Hélène Gersen-Cherdieu
(H)
Denis Collet
(D)
Magalie Cabau
(M)
Christophe Laurent
(C)
Eric Rullier
(E)
Arianna Coniglio
(A)
Charles-Henry Gancel
(CH)
Bogdan Badic
(B)
Gilbert Ouedraogo
(G)
Mircea Beuran
(M)
Aude Brams
(A)
Marc Kanor
(M)
Christophe Louis
(C)
Yves Russier
(Y)
Yves Panis
(Y)
Léon Maggiori
(L)
Camille Caille
(C)
Géraud Tuyeras
(G)
Simon Msika
(S)
Luigi De Magistris
(L)
T Perrin
(T)
Patrick Rat
(P)
Pablo Ortega Deballon
(PO)
Philippe Meignie
(P)
Jean François Bronner
(JF)
Jacques Moline
(J)
Claude Mondersert
(C)
André Caamano
(A)
Catherine Arvieux
(C)
Jean-Luc Faucheron
(JL)
Christian Letoublon
(C)
Antoine Guillaud
(A)
Ségolène Lardenois
(S)
Jean-Michel Nuss
(JM)
Patrick Chevillotte
(P)
Edouard Vinatier
(E)
Williams Tessier
(W)
Robert Caiazzo
(R)
François Pattou
(F)
Nicolas Lamande
(N)
Mehrdad Jafari
(M)
Gauthier Decanter
(G)
François Paraf
(F)
Mohamed Alyami
(M)
Delphine Vaudoyer
(D)
Guillaume Passot
(G)
Olivier Glehen
(O)
Hassan Demian
(H)
Christian Ducerf
(C)
Jean-Yves Mabrut
(JY)
Marc Rivoire
(M)
Vincent Garbit
(V)
Thierry Leclercq
(T)
Jean Loire
(J)
Olivier Raspado
(O)
Rémy Le Huu Nho
(R)
Mehdi Ouaissi
(M)
Igor Sieleznef
(I)
Bernard Sastre
(B)
Bernard Pol
(B)
Manuela Campanile
(M)
Sami Hamed
(S)
Jean Hardwigsen
(J)
Yves-Patrice Le Treut
(YP)
Gérard Carbonnel
(G)
Charlotte de Saint Roman
(C)
M Tréot
(M)
Philippe Sockeel
(P)
Ghislain Tourreau
(G)
Vasileios Baltzopoulos
(V)
Anne Mourregot
(A)
Philippe Rouanet
(P)
L Bresler
(L)
P Senellart
(P)
Guillaume Meurette
(G)
Paul Antoine Lehur
(PA)
Nicolas Regenet
(N)
Vincent Casanova
(V)
Anne Sophie Schneck
(AS)
Antonio Ianelli
(A)
Jean Gugenheim
(J)
Mehdi Karoui
(M)
Jean Christophe Vaillant
(JC)
Jean Baptise Bachet
(JB)
Laurent Hannoun
(L)
Renato Lupinacci
(R)
Francois Menegaux
(F)
Christophe Tresallet
(C)
Antoine Brouquet
(A)
Stéphane Benoist
(S)
Christophe Penna
(C)
Pierre Balladur
(P)
Yann Parc
(Y)
François Paye
(F)
Najim Chafai
(N)
Emmanuel Tiret
(E)
Pierre Cattan
(P)
Emile Sarfati
(E)
Leonor Benhaim
(L)
F Sista
(F)
Sidney Houry
(S)
Pascale Mariani
(P)
Béatrice Ullua Severino
(BU)
Brice Gayet
(B)
Thierry Perniceni
(T)
Jean-Pierre Richer
(JP)
Jean Pierre Faure
(JP)
Jean Louis Kraimps
(JL)
Sophie Deguelte-Lardiere
(S)
Olivier Bouche
(O)
Reza Kianmanesch
(R)
Charles Le Clec'h
(C)
Laurent Sulpice
(L)
Bernard Meunier
(B)
Karim Boudjema
(K)
Emmanuel Huet
(E)
Michel Scotte
(M)
Francis Michot
(F)
Thomas Sole
(T)
Clément Costanza
(C)
Charlotte Vermesch
(C)
Santina Bruno
(S)
Jack Porcheron
(J)
M Raharimanantsoa
(M)
Patrick Pessaux
(P)
Silvana Perretta
(S)
Didier Mutter
(D)
H Mercoli
(H)
A Klipfel
(A)
E H Triki
(EH)
B Romain
(B)
S Dragomir
(S)
N Chilintseva
(N)
J C Olliern
(JC)
Serge Rohr
(S)
Alexandre Rault
(A)
Charles Henri Julio
(CH)
Mael Chalret du Rieu
(MC)
Nicolas Carrere
(N)
Bernard Pradère
(B)
Perrine Senellart
(P)
Baudoin Thébault
(B)
Nicolo De Manzini
(N)
Christophe Henry
(C)
Sylvie Bonvalot
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. Society of Surgical Oncology.
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