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Case Report
Local resection of a pancreatic GIST in the area of the pancreatoduodenal groove. Is the surgical technique a prognostic factor?
1 Associate Chief, Department of General Surgery, Hospital “Rey Juan Carlos”, Rey Juan Carlos University, Móstoles, Madrid, Spain
2 Medical Area Specialist in General Surgery, Department of General Surgery, Hospital “Rey Juan Carlos”, Móstoles, Madrid, Spain
3 Department of Pathology, Hospital “Rey Juan Carlos”, Móstoles, Madrid, Spain
4 Medical Area Specialist in General Surgery, Department of General Surgery, Hospital “El Escorial”, San Lorenzo de El Escorial, Madrid, Spain
5 Chief of Department, General Surgery, Hospital “Rey Juan Carlos”, Rey Juan Carlos University, Móstoles, Madrid, Spain
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Camilo J Castellón Pavón
Associate Chief, Department of General Surgery, Hospital “Rey Juan Carlos”, Rey Juan Carlos University, C/ Gladiolo s/n. 28933, Móstoles, Madrid,
Spain
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Article ID: 100080Z12CC2020
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Castellón CJ, Díaz GA, López P, Paz BA, Morales S, Durán M. Local resection of a pancreatic GIST in the area of the pancreatoduodenal groove. Is the surgical technique a prognostic factor? J Case Rep Images Surg 2020;6:100080Z12CC2020.ABSTRACT
Introduction: Pancreatic gastrointestinal stromal tumors (GISTs) are exceptional. Preoperative diagnosis is difficult, so only the size is useful to determine the possible biological behavior of the tumor. Although surgery is the definitive treatment, the surgical technique is controversial, especially in those tumors located in the area of the pancreatoduodenal groove.
Case Report: We present a case of a 50-year-old woman who complained of abdominal pain. With the diagnostic imaging techniques, a neuroendocrine tumor was suspected at the level of the pancreatoduodenal groove with liver metastases. The patient was treated by radiofrequency of the hepatic lesions and local resection of the pancreatic tumor with a Roux-en-Y duodenojejunostomy. The histological study confirmed the diagnosis of low-risk GIST with spindle cells, so the patient did not receive imatinib. After 11 months of follow-up the patients remained asymptomatic and without signs of recurrent disease.
Conclusion: The main determinants of malignancy for GISTs are tumor size and mitotic index. Surgery is the only curative therapy, although the choice of the most optimal technique to treat pancreatic head GIST is controversial. Nineteen cases published have been reviewed and the influence of the surgical technique on survival has been analyzed. Pancreatoduodenectomy (PD) is the most common procedure performed. Local resection is a safe option provided a complete tumor removal with clear surgical margins is guaranteed. The extension of the surgical resection of pancreatic head GISTs has no statistical significant influence in disease-free survival. The preoperative determining factors for deciding the extension of the resection in pancreatic head GISTs are the size and anatomical relationship with the duodenum and the papilla. Different surgical procedures are suggested depending on the anatomic location.
Keywords: Diagnosis, Extragastrointestinal stromal tumor, Pancreas, Pancreatic neoplasms, Pancreatectomy
SUPPORTING INFORMATION
Author Contributions
Camilo J Castellón Pavón - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gustavo A Díaz García - Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Pedro López Fernández - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Bairon Alfonso Paz Fernández - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sonia Morales Artero - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Manuel Durán Poveda - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Camilo J Castellón Pavón et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
