Duodenal gastrointestinal stroma tumours: Difficulties of an individualized risk assessment and controversies in surgical therapy

摘要

Gastrointestinal stromal tumours (GISTs) are uncommon but distinct mesenchymal tumours of the gastrointestinal tract . They evolve mainly in the stomach (50-60 percent ), while the small intestine (25 percent ) and rectum (5 percent ) are less common sites. Especially the location in the duodenum is very rare with less than 5 percent of patients with GIST [1,2]. Prediction of clinical outcome in patients with GIST still remains difficult. Until now, three key prognostic factors have been characterized for patients with GIST: tumour site, tumour size and mitotic index . Based on these clini-copathologic factors, classification systems by Fletcher, Franquemont, Miettinen and the World Health Organization have been established to predict clinical outcome of patients with GISTs by mainly using the parameters of tumour size and mitotic rate . The optimal therapeutic management of patients with GIST is complete surgical resection with clear tumour margins . Thereby lymphadenectomy may not be required as these tumours are associated with an insignificant sub-mucosal penetration leading to a rare lymphatic involvement.