Chen P, et al. - The surgical approach and long-term outcomes of patients with duodenal gastrointestinal stromal tumors (GISTs) who underwent limited resection (LR) vs. pancreaticoduodenectomy (PD) were evaluated. Rather than a surgical procedure, survival of duodenal GISTs was mainly dependent on tumor biology. For duodenal GISTs, LR ought to be the surgical procedure of choice when technically feasible and no anatomical constrained. Compared by PD, LR indicated similar survival and lower risk of postoperative complications. For duodenal GISTs, the administration of imatinib mesylate (IM) both as adjuvant and neoadjuvant therapy needed large population and prospective study to assess its effectiveness.

• The researchers retrospectively analyzed 64 consecutive patients with duodenal GISTs in a single center from November 2005 to January 2016.
• They examined overall survival (OS), recurrence-free survival (RFS), and perioperative outcomes according to the different surgical type.

• In this study, 41 patients (64.1%) underwent LR, while 23 patients (35.9%) underwent PD.
• The researchers observed negative surgical margins (R0) in all patients.
• For PD, median tumor size was larger (6 cm) vs. LR (4 cm) (P = 0.041).
• Also, PD had more complications than LR (PD, 69.6 vs. LR, 31.7%) (P = 0.002).
• 62.9 and 44.3% was the 3-year and 5-year RFS, respectively.
• 85.7 and 59.5% was the 3-year and 5-year OS, respectively.
• The multivariate analysis indicated that for RFS and OS, the only unfavorable predictive factor was tumor size >5 cm.
• OS and RFS were not affected by the complication although the complication rate in the PD group was higher than in the LR group (P = 0.492 for OS, P = 0.512 for RFS).
• PD vs. LR was not correlated with RFS and OS.
• As per the outcomes, adjuvant imatinib mesylate (IM) did not improve the survival of the patients after operation.