Different Choices of Surgical Methods for Duodenal Gastrointestinal Stromal Tumors

Surgical Approaches for Duodenal GIST

Article information

J Surg Innov Educ. 2025;2(1):22-23

Publication date (electronic) : 2025 June 16

doi : https://doi.org/10.69474/jsie.2024.00150

Zhuang Chun ¹^,²

, Mohd Firdaus Che Ani ²^,³

, Abdullah Almayouf ², Jee-sun Kim ²

, Seong-Ho Kong ²^,⁴

, Do-Joong Park ²^,⁴

, Han-Kwang Yang ²^,⁴

, Hyuk-Joon Lee^,²^,⁴

¹Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

²Division of Gastrointestinal Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea

³Department of Surgery, Faculty of Medicine, University Teknologi MARA, Selangor, Malaysia

⁴Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

Corresponding author: Hyuk-Joon Lee, MD, PhD Division of Gastrointestinal Surgery, Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea Tel: +82-2-2072-1957, Fax: +82-2-766-3975, E-mail: appe98@snu.ac.kr

Received 2024 August 24; Revised 2025 April 2; Accepted 2025 May 13.

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although GISTs can occur anywhere along the GI tract, they are most frequently found in the stomach and small intestine. Duodenal GISTs are rare but clinically significant due to their symptomatology and potential for malignant transformation. Surgical resection remains the cornerstone of curative treatment. Laparoscopic surgery is now the main method for duodenal GIST due to its advantages, including a faster recovery, less pain, and shorter hospital stay. In this video, we demonstrate how we make different choices regarding the surgical methods for duodenal GIST during operation. The technical points are as follows: (1) preliminary judgment of the tumor location according to the preoperative computed tomography scan and gastroscopy findings, (2) fine dissection of the soft tissue and vessels around the duodenum, (3) intraoperative gastroscopy to confirm the tumor location, (4) the final decision regarding the surgical method according to the tumor location and size, (5) confirmation of luminal patency and hemostasis by intraoperative endoscopy.

Chapter Summary

00:00:01 Introduction

00:00:10 Case 1: summary

00:00:18 Look for the tumor by intraoperative endoscopy

00:00:30 Dissect the anterior wall of the duodenum

00:00:45 Dissect the anterior wall of the antrum

00:00:55 Mark the potential margin for gastrectomy

00:01:00 Dissect the greater curvature

00:01:10 Dissect the infrapyloric area

00:01:36 Finally see the tumor

00:02:07 Dissect the duodenum above the pancreas head

00:02:45 Decide to perform gastrectomy with B II anastomosis to avoid narrowness

00:02:50 Cut the duodenum by linear stapler

00:03:10 Mark the proximal margin

00:03:15 Dissect along the lesser curvature

00:03:30 Cut the proximal stomach and make gastrojejunostomy

00:03:42 Close the common hole

00:04:10 Final pathology report

00:04:23 Case 2: summary

00:04:30 Confirm the tumor location

00:04:47 Mark the potential resection margin with the help of endoscopy

00:04:55 Isolate the duodenum and the tumor

00:06:03 Mark the starting point

00:06:15 Open the serosa of the duodenum near the tumor

00:06:25 Whole-layer resection of the tumor

00:06:35 Remove the tumor

00:06:37 Continuous suture the duodenum

00:07:02 Final pathology report

Notes

Disclosure

No potential conflict of interest relevant to this article was reported.

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