Tumores del estroma gastrointestinal del duodeno: revisión de la literatura científica actual con énfasis en el tratamiento

Autores/as

  • Marcelo A. Beltrán Universidad Católica del Norte
  • Catalina Valenzuela Hospital de La Serena
  • Ramón Díaz Hospital de La Serena
  • Yamile Haito Hospital de La Serena
  • Cristóbal Larraín Universidad Católica del Norte

DOI:

https://doi.org/10.30944/20117582.413

Palabras clave:

tumores del estroma gastrointestinal, duodeno, cirugía, terapia neoadyuvante

Resumen

La localización en el duodeno es la más compleja para el tratamiento de los tumores del estroma gastrointestinal (Gastrointestinal Stromal Tumors, GIST). Los GIST duodenales son relativamente infrecuentes, con una prevalencia de 5 % a 7 % de todos los tratados quirúrgicamente. La mayoría de las publicaciones sobre GIST duodenales son reportes de caso o series de casos. Consecuentemente, las manifestaciones clínicas, el diagnóstico radiológico, el tratamiento quirúrgico y los factores pronósticos, constituyen materia de controversia. En el presente artículo se revisa, principalmente, el tratamiento quirúrgico de los GIST duodenales, tratando de establecer las opciones quirúrgicas de acuerdo con su localización. La mayoría de los artículos sobre GIST duodenales mencionan que, a diferencia de otros tumores localizados en el aparato gastrointestinal, el procedimiento óptimo para el tratamiento del GIST duodenal no se encuentra bien caracterizado en la literatura científica. Sin embargo, la revisión de las publicaciones sobre el tema demuestra que el abordaje quirúrgico descrito por diferentes autores es bastante estándar. Todos toman en cuenta la localización del GIST en el duodeno y sus relaciones anatómicas, para decidir entre la resección local o la pancreatoduodenectomía. Utilizando este conocimiento de sentido común, se proponen opciones quirúrgicas para GIST duodenales basadas en su localización en el duodeno.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Marcelo A. Beltrán, Universidad Católica del Norte

Servicio de Cirugía, Hospital de La Serena, IV Región, Facultad de Medicina, Departamento de Clínicas, Universidad Católica del Norte, La Serena, Chile

Catalina Valenzuela, Hospital de La Serena

Servicio de Cirugía, Hospital de La Serena, IV Región, La Serena, Chile

Ramón Díaz, Hospital de La Serena

Servicio de Cirugía, Hospital de La Serena, IV Región, La Serena, Chile

Yamile Haito, Hospital de La Serena

Servicio de Cirugía, Hospital de La Serena, IV Región, La Serena, Chile

Cristóbal Larraín, Universidad Católica del Norte

Servicio de Cirugía, Hospital de La Serena,Facultad de Medicina, Departamento de Clínicas, Universidad Católica del Norte, La Serena, Chile

Referencias bibliográficas

Joensuu H. Gastrointestinal stromal tumor (GIST). Ann Oncol. 2006;17:280-6. https://doi.org/10.1093/annonc/mdl274

Mazur MT, Clark HB. Gastric stromal tumors: Reappraisal of histogenesis. Am J Surg Pathol. 1983;7:507-19. https://doi.org/10.1097/00000478-198309000-00001

Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577-80. https://doi.org/10.1126/science.279.5350.577

Joensuu H, Roberts P, Sarlomo-Rikala M, Andersson LC, Tervahartiala P, Tuveson D, et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with metastatic gastrointestinal stromal tumor. N Engl J Med. 2001;344:1052-6. https://doi.org/10.1056/NEJM200104053441404

Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors: Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol. 2005;16:566-78. https://doi.org/10.1093/annonc/mdi127

van den Abbeele AD. The lessons of GIST-PET and PET/CT: A new paradigm for imaging. Oncologist. 2008;13:8-13. 7. Yang F, Jin C, Du Z, Subedi S, Jiang Y, Li J, et al. Duodenal gastrointestinal stromal tumor: Clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg. 2013;206:360-7. https://doi.org/10.1016/j.amjsurg.2012.11.010

Agaimy A, Wünsch PH. Gastrointestinal stromal tumors: A regular origin in the muscularis propria, but an extremely diverse gross presentation. Langenbecks Arch Surg. 2006;391:322-9. https://doi.org/10.1007/s00423-005-0005-5

Corless CL, Fletcher JA, Heinrich MC. Biology of gastrointestinal stromal tumors. J Clin Oncol. 2004;22:3813-25. https://doi.org/10.1200/JCO.2004.05.140

Kitamura Y. Gastrointestinal stromal tumors: Past, present, and future. J Gastroenterol. 2008;43:499-508. https://doi.org/10.1007/s00535-008-2200-y

Bórquez PM, Neveu RC. Tumores del estroma gastrointestinal (GIST), un particular tipo de neoplasia. Rev Med Chil. 2008;136:921-9. https://doi.org/10.4067/S0034-98872008000700016

Vij M, Agrawal V, Kumar A, Pandey R. Cytomorphology of gastrointestinal stromal tumors and extra-gastrointestinal stromal tumors: A comprehensive morphologic study. J Cytol. 2013;30:8-12. https://doi.org/10.4103/0970-9371.107505

Beltrán MA, Vicencio AO, Barra MM, Contreras MA, Wilson CS, Cruces KS. Resultados del tratamiento quirúrgico de los tumores del estroma gastrointestinal (GIST) en la IV Región de Chile. Rev Chil Cir. 2011;63:290-6. https://doi.org/10.4067/S0718-40262011000300009

Beltrán MA, Pujado B, Méndez PE, Gonzáles FJ, Margulis DI, Contreras MA, et al. Gastric Gastrointestinal Stromal Tumor (GIST) incidentally found and resected during laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:393-6. https://doi.org/10.1007/s11695-009-0009-2

Uchida H, Sasaki A, Iwaki K, Tominaga M, Yada K, Iwashita Y, et al. An extramural gastrointestinal stromal tumor of the duodenum mimicking a pancreatic head tumor. J Hepatobiliary Pancreat Surg. 2005;12:324-7. https://doi.org/10.1007/s00534-005-0985-0

Huang CC, Yang CY, Lai IR, Chen CN, Lee PH, Lin MT. Gastrointestinal stromal tumor of the small intestine: A clinicpathologic study of 70 cases in the postimatinib era. World J Surg. 2009;33:828-4. https://doi.org/10.1007/s00268-009-9918-4

Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, et al. Management and outcome of gastrointestinal stromal tumors of the duodenum. J Gastrointest Surg. 2010;14:880-3. https://doi.org/10.1007/s11605-010-1170-6

Lin C, Chang Y, Zhang Y, Zuo Y, Ren S. Small duodenal gastrointestinal stromal tumor presenting with acute bleeding misdiagnosed as hemobilia: Two case reports. Oncol Lett. 2012;4:1069-71. https://doi.org/10.3892/ol.2012.838

Johnston FM, Kneuertz PJ, Cameron JL, Sanford D, Fisher S, Turley R, et al. Presentation and management of gastrointestinal stromal tumors of the duodenum: A multi-institutional analysis. Ann Surg Oncol. 2012;19:3351-60. https://doi.org/10.1245/s10434-012-2551-8

Colombo C, Ronellenfitsch U, Yuxin Z, Rutkowski P, Miceli R, Bylina E, et al. Clinical, pathological and surgical characteristics of duodenal gastrointestinal stromal tumor and their influence on survival: A multi-center study. Ann Surg Oncol. 2012;19:3361-7. https://doi.org/10.1245/s10434-012-2559-0

Beham A, Schaefer IM, Cameron S, von Hammerstein K, Füzesi L, Ramadori G, et al. Duodenal GIST: A single center experience. Int J Colorectal Dis. 2013;28:581-90. https://doi.org/10.1007/s00384-012-1432-8

Mosquera MS, Abiyoma AK, Sánchez G, Téllez LJ, PérezJM, Varón C, et al. Tumores estromales gastrointestinales: enfoque actual. Presentación de seis casos. Rev Colomb Cir. 2004;19:116-25.

Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol. 2002;33:459-65. https://doi.org/10.1053/hupa.2002.123545

Rutkowski P, Bylina E, Wozniak A, Nowecki ZI, Osuch C, Matlok M, et al. Validation of the Joensuu risk criteria for primary resectable gastrointestinal stromal tumor - The impact of tumor rupture on patient outcomes. Eur J Surg Oncol. 2011;37:890-6. https://doi.org/10.1016/j.ejso.2011.06.005

Beltrán MA, Barría C, Contreras MA, Wilson CS, Cruces KS. Tumor del estroma gastrointestinal (GIST) en una paciente con neurofibromatosis tipo 1. Rev Med Chil. 2009;137:1197-200. https://doi.org/10.4067/S0034-98872009000900009

Relles D, Baek J, Witkiewicz A, Yeo CJ. Periampullary and duodenal neoplasms in neurofibromatosis type 1: Two cases and an updated 20-year review of the literature yielding 76 cases. J Gastrointest Surg. 2010;14:1052-61. https://doi.org/10.1007/s11605-009-1123-0

Agaimy A, Vassos N, Croner RS. Gastrointestinal manifestations of neurofibromatosis type 1 (Recklinghausen's disease) Clinico-pathological spectrum with pathogenetic considerations. Int J Clin Exp Pathol. 2012;5:852-62.

Beltrán MA, Cruces KS, Barría C, Verdugo G. Multiple gastrointestinal stromal tumors of the ileum and neurofibromatosis type 1. J Gastrointest Surg. 2006;10:297-301. https://doi.org/10.1016/j.gassur.2005.05.007

Arango LA, Santacoloma M, Urbano CA. Tumores estromales gastrointestinales. Una visión actual. Rev Colomb Cir. 2006;21:190-5.

Lee CM, Chen HC, Leung TK, Chen YY. Gastrointestinal stromal tumor: Computed tomographic features. World J Gastroenterol. 2004;10:2417-8. https://doi.org/10.3748/wjg.v10.i16.2417

Burkill GJ, Badran M, Al-Muderis O, Thomas JM, Judson IR, Fisher C, et al. Malignant gastrointestinal stromal tumor: Distribution, imaging features, and pattern of metastatic spread. Radiology. 2003;226:527-32. https://doi.org/10.1148/radiol.2262011880

Hersh MR, Choi J, Garrett C, Clark R. Imaging gastrointestinal stromal tumors. Cancer Control. 2005;12:111-115. https://doi.org/10.1177/107327480501200206

Kim JY, Lee JM, Kim KW, Park HS, Choi JY, Kim SH, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology. 2009;252:92-100. https://doi.org/10.1148/radiol.2521081441

Chourmouzi D, Sinakos E, Papalavrentios L, Akriviadis E, Drevelegas A. Gastrointestinal stromal tumors: A pictorial review. J Gastrointest Liver Dis. 2009;18:379-83.

Buckley JA, Fishman EK. CT evaluation of small bowel neoplasms: Spectrum of disease. RadioGraphics. 1998;18:379-92. https://doi.org/10.1148/radiographics.18.2.9536485

Ulusan S, Koc Z, Kayaselcuk F. Gastrointestinal stromal tumours: CT findings. Br J Radiol. 2008;81:518-623. https://doi.org/10.1259/bjr/90134736

Lupescu IG, Grasu M, Boros M, Gheorghe C, Ionescu M, Popescu I, et al. Gastrointestinal stromal tumors: Retrospective analysis of the computer-tomographic aspects. J Gastrointest Liver Dis. 2007;16:147-51.

Chandrasekhara V, Ahmad NA. EUS-Guided fine needle aspiration of gastrointestinal stromal tumors: The GIST of the matter. Dig Dis Sci. 2011;56:1596-8. https://doi.org/10.1007/s10620-011-1713-z

Watson RR, Binmoeller KF, Hamerski CM, Shergill AK, Shaw RE, Jafee IM, et al. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing GI tract stromal tumors. Dig Dis Sci. 2011;56:1757-62. https://doi.org/10.1007/s10620-011-1646-6

Kim MN, Kang SJ, Kim SG, Im JP, Kim JS, Jung HC, et al. Prediction of risk malignancy of gastrointestinal stromal tumors by endoscopic ultrasonography. Gut Liver. 2013;7:642-7. https://doi.org/10.5009/gnl.2013.7.6.642

Pavlovic MA, Rösch T, Alempijevic T, Krstic M, Tomic D, Dugalic P, et al. Endoscopic ultrasound for differential diagnosis of duodenal lesions. Ultraschall Med. 2012;33:210-7. https://doi.org/10.1055/s-0032-1313135

Prachayacul V, Aswakul P, Pongprasobchai S, Pausawasdi N, Akaraviputh T, Sriprayoon T, et al. Clinical characteristics, endosonographic findings and etiologies of gastroduodenal subepithelial lesions: A Thai referral single center study. J Med Assoc Thai. 2012;95:S61-7.

Krause DS, van Etten RA. Tyrosine kinases as targets for cancer therapy. N Engl J Med. 2005;353:172-87. https://doi.org/10.1056/NEJMra044389

Demetri GD, von Mehren M, Blanke CD, van den Abbeele AD, Eisenberg B, Roberts PJ, et al. Efficacy and safety of imatinib mesilate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347:472-80. https://doi.org/10.1056/NEJMoa020461

Ludvigsen L, Toxvaerd A, Mahdi B, Krarup-Hansen A, Bergenfeldt M. Successful resection of an advanced duodenal gastrointestinal stromal tumor after down-staging with imatinib: Report of a case. Surg Today. 2007;37:1105-9. https://doi.org/10.1007/s00595-007-3544-2

Rutkowski P, Gronchi A, Hohenberger P, Bonvalot S, Schöffski P, Bauer S, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): The EORTC STBSG experience. Ann Surg Oncol. 2013;20:2937-43. https://doi.org/10.1245/s10434-013-3013-7

NCCN. Clinical practice guidelines in oncology. Soft tissue sarcoma 2012, version 2.2012.

The ESMO/European Sarcoma Network Working Group. Gastrointestinal stromal tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23:49-55. https://doi.org/10.1093/annonc/mds252

Wu TJ, Lee LY, Yeh CN, Wu PY, Chao TC, Hwang TL, et al. Surgical treatment and prognostic analysis for gastrointestinal stromal tumors (GISTs) of the small intestine: Before the era of imatinib mesylate. BMC Gastroenterol. 2006;6:29. https://doi.org/10.1186/1471-230X-6-29

Buchs NC, Bucher P, Gervaz P, Ostermann S, Pugin F, Morel P. Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum. World J Gastroenterol. 2010;16:2788-92. https://doi.org/10.3748/wjg.v16.i22.2788

Tien YW, Lee CY, Huang CC, Hu RH, Lee PH. Surgery for gastrointestinal stromal tumors of the duodenum. Ann Surg Oncol. 2010;17:109-14. https://doi.org/10.1245/s10434-009-0761-5

El-Gendi A, El-Gendi S, El-Gendi M. Feasibility and oncological outcomes of limited duodenal resection in patients with primary nonmetastatic duodenal GIST. J Gastrointest Surg. 2012;16:2197-202. https://doi.org/10.1007/s11605-012-2034-z

Bourgouin S, Hornez E, Guiramand J, Barbier L, Delpero JR, Le Treut YP, et al. Duodenal gastrointestinal stromal tumors (GISTs): Arguments for conservative surgery. J Gastrointest Surg. 2013;17:482-7. https://doi.org/10.1007/s11605-012-2075-3

Yildirgan MI, Başoğ M, Atamanalp SS, Albayrak Y, Gürsan N, Önbaş Ö. Duodenal stromal tumor: Report of a case. Surg Today. 2007;37:426-9. https://doi.org/10.1007/s00595-004-3400-6

Sakakima Y, Inoue S, Fujii T, Hatsuno T, Takeda S, Kaneko T, et al. Emergency pylorus-preserving pancreatoduodenectomy followed by second-stage pancreatojejunostomy for a gastrointestinal stromal tumor of the duodenum with intramural gas figure: Report of a case. Surg Today. 2004;34:701-5. https://doi.org/10.1007/s00595-004-2771-z

Asakama M, Sakamoto Y, Kajiwara T, Nara S, Esaki M, Shimada K, et al. Simple segmental resection of the second portion of the duodenum for the treatment of gastrointestinal stromal tumors. Langenbecks Arch Surg. 2008;393:605-9. https://doi.org/10.1007/s00423-007-0243-9

Morcos B, Al-Ahmad F. A large gastrointestinal stromal tumor of the duodenum: Report of a case. J Med Case Reports. 2011;5:457. https://doi.org/10.1186/1752-1947-5-457

Sakamoto Y, Yamamoto J, Takahashi H, Kokudo N, Yamaguchi T, Muto T, et al. Segmental resection of the third portion of the duodenum for a gastrointestinal stromal tumor: A case report. Jpn J Clin Oncol. 2003;33:364-6. https://doi.org/10.1093/jjco/hyg063

Mennigen R, Wolters HH, Schulte B, Pelster FW. Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST). World J Surg Oncol. 2008;6:105. https://doi.org/10.1186/1477-7819-6-105

Ghidirim G, Mishin I, Gagauz I, Vozian M, Cernii A, Cernat M. Duodenal gastrointestinal stromal tumor. Rom J Morphol Embryol. 2011;52(Suppl.3):1121-5.

Shaw A, Jeffery J, Dias L, Nazir S. Duodenal wedge resection for large gastrointestinal stromal tumor (GIST) presenting with life-threatening hemorrhage. Case Reports Gastrointest Med. 2013;2013:562642. http://dx.doi.org/10.1155/2013/562642. https://doi.org/10.1155/2013/562642

Sasaki A, Koeda K, Obuchi T, Nakajima J, Nishizuka S, Terashima M, et al. Tailored laparoscopic resection for suspected gastric gastrointestinal stromal tumor. Surgery. 2010;147:516-20. https://doi.org/10.1016/j.surg.2009.10.035

Chen YH, Lu KH, Yeh CN, Hsu JT, Liu YY, Tsai CY, et al. Laparoscopic resection of gastrointestinal tumors: Safe, efficient, and comparable oncologic outcomes. J Laparoendosc Adv Srug Tech. 2012;22:758-63. https://doi.org/10.1089/lap.2012.0115

Bickenbach K, Wilcox R, Veerapong J, Kindler HL, Posner MC, Noffsinger A, Roggin KK. A review of resistance patterns and phenotypic changes in gastrointestinal stromal tumors following imatinib mesylate therapy. J Gastrointest Surg. 2007;11:758-66. https://doi.org/10.1007/s11605-007-0150-y

Wang CM, Huang K, Zhou Y, Du CY, Ye YW, Fu H, et al. Molecular mechanisms of secondary imatinib resistance in patients with gastrointestinal tumors. J Cancer Res Clin Oncol. 2010;136:1065-71. https://doi.org/10.1007/s00432-009-0753-7

Rink L, Skorobogatko Y, Kossenkov AV, Belinsky MG, Pajak T, Heinrich MC, et al. Gene expression signatures and response to imatinib mesilate in gastrointestinal stromal tumor. Mol Cancer Ther. 2009;8:2172-82. https://doi.org/10.1158/1535-7163.MCT-09-0193

Gounder MM, Maki RG. Molecular basis for primary and secondary tyrosine kinase inhibitor resistance in gastrointestinal stromal tumor. Cancer Chemother Pharmacol. 2011;67:25-43. https://doi.org/10.1007/s00280-010-1526-3

Yeh CN, Chen TW, Tseng JH, Liu YY, Wang SY, Tsai CY, et al. Surgical management in metastatic gastrointestinal stromal tumor (GIST) patients after imatinib mesilate treatment. J Surg Oncol. 2010;102:599-603. https://doi.org/10.1002/jso.21630

Andtbacka RH, Ng CS, Scaife CL, Cormier JN, Hunt KK, Pisters PW, et al. Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol. 2007;14:14-24. https://doi.org/10.1245/s10434-006-9034-8

D'Amato G, Steinert DM, McAuliffe JC, Trent JC. Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control. 2005;12:44-55. https://doi.org/10.1177/107327480501200106

Blay JY. Pharmacological treatment of gastrointestinal stromal tumors: An update on the role of sunitinib. Ann Oncol. 2010;21:208-15. https://doi.org/10.1093/annonc/mdp291

Younus J, Verma S, Franek J, Coakley N. Sunitinib maleate for gastrointestinal stromal tumor imatinib mesylate-resistant patients: Recommendations and evidence. Current Oncol. 2010;17:4-10. https://doi.org/10.3747/co.v17i4.560

Kikuchi H, Setoguchi T, Miyazaki S, Yamamoto M, Ohta M, Kamiya K, et al. Surgical intervention for imatinib and sunitinib-resistant gastrointestinal stromal tumors. Int J Clin Oncol. 2011;16:741-5. https://doi.org/10.1007/s10147-011-0208-4

Wang WL, Conley A, Reynoso D, Nolden L, Lazar AJ, George S, et al. Mechanisms of resistance to imatinib and sunitinib gastrointestinal stromal tumor. Cancer Chemother Pharmacol. 2011;67:15-24. https://doi.org/10.1007/s00280-010-1513-8

Dudeja V, Armstrong LH, Gupta P, Ansel H, Askari S, Al-Refaie WB. Emergence of imatinib resistance associated with down regulation of c-kit expression in recurrent gastrointestinal stromal tumor (GIST): Optimal timing of resection. J Gastrointest Surg. 2010;14:557-61. https://doi.org/10.1007/s11605-009-1121-2

Montemurro M, Bauer S. Treatment of gastrointestinal stromal tumor after imatinib and sunitinib. Curr Opin Oncol. 2011;23:367-72. https://doi.org/10.1097/CCO.0b013e3283477ac2

Sawaki A, Nishida T, Doi T, Yamada Y, Komatsu Y, Kanda T, et al. Phase 2 study of nilotinib as third-line therapy for patients with gastrointestinal stromal tumor. Cancer. 2011;117:4633-41. https://doi.org/10.1002/cncr.26120

Descargas

Publicado

2014-06-20

Cómo citar

(1)
Beltrán, M. A.; Valenzuela, C.; Díaz, R.; Haito, Y.; Larraín, C. Tumores Del Estroma Gastrointestinal Del Duodeno: Revisión De La Literatura científica Actual Con énfasis En El Tratamiento. Rev Colomb Cir 2014, 29, 140-154.

Número

Sección

Artículo de Revisión

Métricas

Crossref Cited-by logo
QR Code

Algunos artículos similares: