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
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

6294-6306

Investigateurs

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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Auteurs

Clément Dubois (C)

Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.

Frederiek Nuytens (F)

Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France. frederiek.nuytens@gmail.com.

Hélène Behal (H)

University Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France.

Caroline Gronnier (C)

Department of Digestive Surgery, Haut Lévêque University Hospital, Bordeaux, France.

Gilles Manceau (G)

Department of Digestive Surgery, Pitié-Salpêtrière University Hospital, Paris, France.

Maxime Warlaumont (M)

Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.

Alain Duhamel (A)

University Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, Lille, France.

Quentin Denost (Q)

Department of Digestive Surgery, Haut Lévêque University Hospital, Bordeaux, France.

Charles Honoré (C)

Department of Surgery, Institut Gustave Roussy, Villejuif, France.

Olivier Facy (O)

Department of Digestive Surgery, Dijon University Hospital, Dijon, France.

Jean-Jacques Tuech (JJ)

Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France.

Guido Tiberio (G)

General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Cécile Brigand (C)

Department of Digestive Surgery, Hautepierre University Hospital, Strasbourg, France.

Jean-Pierre Bail (JP)

Department of Digestive Surgery, Brest University Hospital, Brest, France.

Ephrem Salame (E)

Department of Digestive Surgery, Tours University Hospital, Tours, France.

Bernard Meunier (B)

Department of Digestive Surgery, Pontchailloux University Hospital, Rennes, France.

Jérémie H Lefevre (JH)

Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.

Muriel Mathonnet (M)

Department of Digestive Surgery, Limoges University Hospital, Limoges, France.

Mohamed Sbai Idrissi (MS)

Department of Digestive Surgery, Clinique Claude Bernard RAMSAY, Ermont, France.

Florence Renaud (F)

Department of Pathology, Lille University Hospital, Lille, France.
University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.

Guillaume Piessen (G)

Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.
University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.

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