Pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors: a systematic review and meta-analysis

• Main Authors: Zefeng Shen, Ping Chen, Nannan Du, Parishit A. Khadaroo, Danyi Mao, Lihu Gu
• Format: Article
• Language: English
• Published: BMC 2019-08-01
• Series: BMC Surgery
• Subjects: Duodenal gastrointestinal stromal tumors; Pancreaticoduodenectomy; Limited resection; Prognosis; Meta-analysis
• Online Access: http://link.springer.com/article/10.1186/s12893-019-0587-4

Abstract Background By comparing the long-term prognostic outcomes after pancreaticoduodenectomy (PD) and limited resection (LR), this study aimed to investigate the optimal surgical modality for duodenal gastrointestinal stromal tumors (GISTs). Methods Two authors independently searched PubMed, Web of Science, Embase, and the Cochrane Library for published articles comparing the long-term prognostic and clinicopathological factors of duodenal GIST patients undergoing PD versus LR. Relevant information was extracted and analyzed. Results After screening, 10 items comprising 623 cases were eventually included. This meta-analysis explicitly indicated that PD treatment was associated with worse long-term prognosis (hazard ratio = 1.93; 95% confidence interval [CI], 1.39–2.69; p < 0.001; I2 = 0) and more complications (odds ratio [OR] = 2.90; 95% CI, 1.90–4.42; p < 0.001; I2 = 10%) than LR treatment. Nevertheless, for duodenal GISTs, PD was related to the following clinicopathological features: invasion of the second part of the duodenum (OR = 3.39; 95% CI, 1.69–6.79; p < 0.001; I2 = 50%), high-degree tumor mitosis (> 5/50 high-power fields; OR = 2.24; 95% CI, 1.42–3.52; p < 0.001; I2 = 0), and high-risk classification (OR = 3.17; 95% CI; 2.13–4.71; p < 0.001; I2 = 0). Conclusions Since PD is associated with worse long-term prognosis and more complications, its safety and efficacy should be ascertained. Our findings recommend the use of LR to obtain negative incision margins when conditions permit it.