Laparoscopic Resection of Gastrointestinal Stromal Tumors Located at the Gastroesophageal Junction

Introduction
Gastrointestinal stromal tumors are the most common mesenchymal neoplasm of the GI tract, and 60% of GISTs occur in the stomach. The mainstay of treatment for GI stromal tumors is surgical resection with negative margins, with use of Gleevac reserved for metastatic or unresectable disease. Tumors located at the gastroesophageal junction have traditionally been problematic as even limited resection of small tumors may deform the GE junction and cause dysphagia. Historically, GI stromal tumors located in close proximity to the GE junction have required transhiatal esophagectomy. Advancement in minimally invasive techniques has allowed resection of even larger GISTs via a laparoscopic approach. We describe a case series of 4 patients with gastrointestinal stromal tumors located at or near the gastroesophageal junction using a laparoscopic approach.

Methods and Prodcedures
Four patients age 42 to 63 years underwent elective laparoscopic of an intraluminal gastrointestinal stromal tumor located at the gastroesophageal junction. Tumor size ranged from 3-6 cm and distance from GE junction ranged from 0-2 cm. All patients underwent upper endoscopy at the time of surgery to confirm location of the tumor. After establishment of pneumoperitoneum, an anterior gastrotomy was made to allow access to the tumor. A bougie was placed to avoid narrowing or deforming the GE junction. Using endoscopic staplers, the tumors were resected with negative margins without causing deformity to the GE junction.

Results
No conversions to an open procedure were necessary. There were no complications during procedure or hospital stay for any patient.
All patients were discharged home tolerating a regular diet within 4 days postoperatively.

Conclusion
Laparoscopic resection of GIST tumors located at or near the gastroesophageal junction may be performed with negative margins and is safe and technically feasible without causing clinically significant luminal narrowing.

Session: Poster

Program Number: P267