Abstract
DGIST represents a small subset, accounting for 4-5% of all GIST. The intricacies of the duodenum's anatomy had led to a scarcity of comprehensive surgical guidelines for its management. Ours is a high-volume pancreaticobiliary unit, and we retrospectively evaluated the management and outcomes of patients with duodenal GIST to formulate an algorithm. We retrospectively analyzed the demographics, perioperative outcomes, and survival data of 25 patients who were operated for DGIST from 2008 to 2021 in the Department of Surgical Gastroenterology. Out of 25 patients, 23 patients (92%) underwent LR, whereas the other 2 patients (8%) underwent PD. The most common type of LR performed was segmental resection with reconstruction (72%). The most common location was in the second (40%, n = 10) part of the duodenum. The median tumor size of the entire cohort was 4 cm. The majority of the patients had negative surgical margin (R0) (PD, 100%; LR, 96%). The 10-year overall survival (OS) for LR and PD was 89.3% and 50% (p = 0.354), while the 10-year disease-free survival (DFS) was 89.7% and 50% (p = 0.217), respectively. A management algorithm was proposed based on our experience. DGIST is a rare entity for which the surgical algorithm is unclear. In experienced hands, morbid surgery (like Whipple's) can be avoided in most of the patients with modified duodenal resection even for large tumors with good oncological outcomes. Neoadjuvant TKI should be used whenever mandated to avoid multiorgan resections.