十二指肠胃肠道间质瘤的外科治疗。

Surgery for gastrointestinal stromal tumors of the duodenum.

机构信息

Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.

出版信息

Ann Surg Oncol. 2010 Jan;17(1):109-14. doi: 10.1245/s10434-009-0761-5. Epub 2009 Oct 20.

DOI:10.1245/s10434-009-0761-5

PMID:19841981

Abstract

BACKGROUND

Duodenal gastrointestinal stromal tumors (GISTs) represent a unique dilemma with varied surgical treatment options. However, the impact of operative methods on disease recurrence has never been addressed.

METHODS

We retrospectively reviewed the medical records of all patients with duodenal GISTs treated at our hospital from January 2001 to December 2008.

RESULTS

Of the 25 patients included for analysis, 9 had pancreaticoduodenectomy (PD) and 16 had limited operation. Comparison of clinicopathological data between tumors treated by PD and by limited operation showed no significant differences in patient age, sex, symptoms, location of tumor, tumor grade, immunohistochemical staining pattern, or complications after surgery. However, patients with tumors >5 cm (P = 0.005) or not diagnosed as GISTs before surgery (P = 0.004) were significantly more frequently treated by PD. In multivariable analysis, the only significant predictor for disease recurrence was high-risk duodenal GISTs.

CONCLUSIONS

Based on the fact that type of operation was not correlated to operative risk and disease recurrence, limited operation rather than PD should be attempted for duodenal GIST without involvement of papilla of Vater to preserve more pancreas parenchyma, duodenum, and common bile duct.

摘要

背景

十二指肠胃肠道间质瘤（GIST）具有多种手术治疗选择，这是一个独特的困境。然而，手术方法对疾病复发的影响从未被涉及。

方法

我们回顾性地审查了 2001 年 1 月至 2008 年 12 月在我院治疗的所有十二指肠 GIST 患者的病历。

结果

在纳入分析的 25 例患者中，9 例行胰十二指肠切除术（PD），16 例行有限手术。PD 与有限手术治疗的肿瘤的临床病理数据比较显示，患者年龄、性别、症状、肿瘤位置、肿瘤分级、免疫组织化学染色模式或手术后并发症无显著差异。然而，肿瘤>5cm（P=0.005）或术前未诊断为 GIST 的患者（P=0.004）更常行 PD 治疗。多变量分析显示，疾病复发的唯一显著预测因子是高危十二指肠 GISTs。