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Robotic resection of duodenal gastrointestinal stromal tumour:Preliminary experience from a single centre

World Journal of Gastrointestinal Oncology 2021年第7期13卷 706-715页

作者： Zhi-Peng Zhou Xiang-Long Tan Zhi-Ming Zhao Yuan-Xing Gao Yu-Yao Song Yu-Ze Jia Cheng-Gang Li Department of Hepato-Pancreato-Biliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical method.AIM To summarize the technique and feasibility of robotic resection of DGISTs.METHODS The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively analyzed.The patients were divided into the open surgery group and the robotic surgery group.Pancreatoduodenectomy(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla.Age,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two groups.RESULTS Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 years.limited resection was performed in 17 patients,and PD was performed in 11 patients.Eleven patients underwent open surgery,and 17 patients underwent robotic surgery.Two patients in the robotic surgery group underwent conversion to open surgery.All the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGISTs,and its therapeutic effect is equivalent to

关键词： Gastrointestinal stromal tumor Duodenum Pancreaticoduodenectomy limited resection Robotic resection

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Current surgical management of duodenal gastrointestinal stromal tumors

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1166-1179页

作者： Kheng Tian Lim Department of Surgery Khoo Teck Puat HospitalSingapore 768828Singapore

Duodenal gastrointestinal stromal tumors(D-GISTs)are uncommon mesenchymal tumors and are managed differently to common duodenal epithelial tumors.They may pose surgical challenges due to their unique but complex pancreaticoduodenal location of the gastrointestinal tract near the ampulla of Vater,pancreas,mesenteric blood vessels,biliary and pancreatic ducts.The surgical management of D-GISTs can be performed safely with good oncological outcomes provided an adequate resection margin can be achieved.The current surgical options of resectable primary D-GISTs varies with increasing complexity depending on the location,size and involvement of surrounding structures such as wedge resection with primary closure,segmental resection with small bowel anastomosis or radical pancreaticoduodenectomy.Laparoscopic approaches have been shown to be feasible and safe with good oncological outcomes in experienced hands.The minimally invasive techniques including robotic-assisted approach will likely increase in the future.D-GISTs have a prognosis comparable to gastric and other small bowel GISTs.However,the heterogeneity of different studies and the limited use of systemic tyrosine kinase inhibitor in the neoadjuvant and adjuvant settings may influence the overall survival of resected D-GISTs.The use of limited resection when condition allows is recommended due to lower surgical morbidity,less postoperative complications and better oncologic outcomes.

关键词： Duodenum Gastrointestinal stromal tumors limited resection Pancreaticoduodenectomy Survival

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