Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor.
Surgical Strategy and Outcomes in Duodenal Gastrointestinal Stromal Tumor.
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DOI：
10.1245/s10434-016-5565-9
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发表时间：
2017-01
影响因子：
3.7
通讯作者：
DeMatteo RP
中科院分区：
文献类型：
--
作者：
Lee SY;Goh BK;Sadot E;Rajeev R;Balachandran VP;Gönen M;Kingham TP;Allen PJ;D'Angelica MI;Jarnagin WR;Coit D;Wong WK;Ong HS;Chung AY;DeMatteo RP
十二指肠胃肠道间质瘤（DGIST）的外科治疗特点不多。有限切除术在技术上可行且在肿瘤学上安全，但由于靠近关键结构，解剖学考虑可能会损害切除边缘，从而需要更广泛的切除术，如胰腺切除术。确定了1994-2014年在2家机构接受DGIST手术的患者。临床病理和生存数据进行了分析，以比较有限或根治性切除治疗的患者的结果。60例患者接受了DGIST手术。38%的患者行胰管切除术，其余患者行有限切除术。最常见的有限切除类型是楔形切除和一期缝合（49%），其次是节段切除和端端或侧侧十二指肠空肠吻合术（27%）。胰腺切除术组倾向于有较大的肿瘤，大多数位于D2/3（87%）和肠系膜边缘（91%）。胰管切除术组的术中失血量明显更大，手术时间更长，住院时间更长，90天发病率和再入院率更高。胰腺癌切除术与局限性切除术的5年无复发生存率（RpFS）、无复发生存率（RFS）和总生存率（OS）分别为81% vs. 56%（p = 0.05）、64% vs. 53%（p = 0.5）和76% vs. 72%（p = 0.6）。提出了一种基于肿瘤位置和大小的手术算法。DGIST的有限切除是安全的，但可能与较低的5年无复发生存率相关。对于选定的DGIST患者，如果不切除壶腹或部分胰腺就无法进行R 0切除，则建议进行胰腺切除术。
The surgical management of duodenal gastrointestinal stromal tumors (DGIST) is poorly characterized. Limited resection may be technically feasible and oncologically safe, but anatomical considerations may compromise the resection margins due to the proximity of critical structures, thereby necessitating more extensive resections such as pancreaticoduodenectomy. Patients undergoing surgery for DGIST at 2 institutions from 1994–2014 were identified. Clinicopathologic and survival data were analyzed to compare outcomes in patients treated with limited or radical resection. Sixty patients underwent surgery for DGIST. Pancreaticoduodenectomy was performed in 38% while the rest underwent limited resections. The most common type of limited resection was wedge resection and primary closure (49%) followed by segmental resection with an end-to-end or side-to-side duodenojejunostomy (27%). The pancreaticoduodenectomy group tended to have larger tumors with the majority located in D2/3 (87%) and at the mesenteric border (91%). The pancreaticoduodenectomy group also had significantly greater intraoperative blood loss, longer operative time, longer hospital stay, and higher 90-day morbidity and readmission rates. The 5- year relapse-free survival (RpFS), recurrence-free survival (RFS), and overall survival (OS) for the pancreaticoduodenectomy vs. limited resection were 81% vs. 56% (p = 0.05), 64% vs. 53% (p = 0.5), and 76% vs. 72% (p = 0.6), respectively. A surgical algorithm based on the location and size of the tumor is proposed. Limited resection of DGIST is safe, but may be associated with lower 5-year relapse-free survival. Pancreaticoduodenectomy is recommended for selected patients with DGIST when an R0 resection cannot be performed without removing the ampulla or part of the pancreas.
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DOI：
10.1016/j.jamcollsurg.2012.05.008
发表时间：
2012-07
影响因子：
5.2
作者：
McCarter, Martin D.;Antonescu, Cristina R.;Ballman, Karla V.;Maki, Robert G.;Pisters, Peter W. T.;Demetri, George D.;Blanke, Charles D.;von Mehren, Margaret;Brennan, Murray F.;McCall, Linda;Ota, David M.;DeMatteo, Ronald P.
通讯作者：
DeMatteo, Ronald P.
影响因子：
3.8
作者：
Duffaud, F.;Meeus, P.;Bonvalot, S.
通讯作者：
Bonvalot, S.
影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
3.7
作者：
Hohenberger, Peter;Eisenberg, Burton
通讯作者：
Eisenberg, Burton
影响因子：
45.3
作者：
Corless, CL;Fletcher, JA;Heinrich, MC
通讯作者：
Heinrich, MC