Yoelimar Guzman, MD, Dulce Momblan, MD, Ainitze Ibarzabal, MD, Victor Turrado, MD, Gerard Frigola, MD, Jaume Balust, MD, Antonio Lacy, MD, PhD. Hospital Clinic of Barcelona
Case summary: 48-year-old female affected by gastrointestinal stromal tumor (GIST), stage IIIA, located in the 3rd/4th duodenal part, diagnosed because a history of microcytic anemia and abdominal discomfort. After receiving neoadjuvant treatment with Imatinib from April 2017 to May 2018 and achieving the maximum of size reduction (12 to 5 cm), she underwent surgery to perform a tumor resection.
Surgery: the resection was carried out by laparoscopic approach. The patient was placed in the supine position with open legs. The surgeon stood between the legs and an assistant at each side of the patient. The trocars’ placement was as following: supraumbilical position for a 3D scope, 12mm and 5mm at the left flank, 5mm at the right flank and 5mm at epigastrium.
Inspection of abdominal cavity was performed in order to rule out any contraindication to the surgery. First step was mobilizing the Treitz angle, after which was possible to access to the tumor. It was localized in 3rd duodenal part and extents to the 4th part and seemed not to infiltrate adjacent structures. Carefully dissection was performed to release the tumor of the adjacent planes. It was difficult to determine whether the Superior Mesenteric Artery (SMA) was infiltrated by the tumor and also it occurred hemorrhage in the surgical field. Because of that a Hand Assist Device was placed using a Pfannestiel incision. This device allowed to rule out the SMA infiltration, a better bleeding control and let the surgery to be completed properly with greater security. The tumor was resected with 5 cm of uninvolved duodenal margins using an endostapler. Posteriorly, a side-to-side mechanical anastomosis was performed between the descending duodenum and the proximal jejunum employing a stapler device.
Outcome: The patient started oral intake 48 hours after surgery and was discharged at the 5th postoperative day. The pathology report was: gastrointestinal stromal tumor with C-KIT mutation, proliferation index Ki 67 up to 80% in some areas, free resection margins.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94693
Program Number: V129
Presentation Session: Solid Organ Videos
Presentation Type: Video