Gaurav Singh, Dr, Yashas H Ramegowda, Dr, Srikanth Gadiyaram, Dr. Sahasra Hospitals, Centre of Excellence for Gastroenterology, Bangalore, India
Introduction: Organ preservation is a cornerstone in the surgical removal of gastro-intestinal stromal tumors (GISTs). Laparoscopic surgery and the current surgical technology have enabled the same in the management of GISTs near gastro-esophageal junction (GEJ), without the need of a total gastrectomy.
Methods and Procedures: This is a retrospective analysis from a prospective database of consecutive patients who were diagnosed to have GISTs located near GEJ (GEJ GIST) during last twelve years and underwent resection for the same by a single surgeon. GEJ GISTs were defined as those with an upper border within 5 centimeters of esophago-gastric line. Clinico-pathologic details, intra-operative course, short and long term outcomes were analyzed.
Results: A total of nine patients were planned for the laparoscopic resection of GEJ GISTs. All the procedures were completed laparoscopically without any intra-operative complications. The mean age of the patients was 54±17 years with a male:female ratio of 8:1. The most common presentation was epigastric pain/discomfort (5), followed by an incidental imaging finding (2), malena (1) and dysphagia (1). The mean tumor size was 4.5±1.1 cm. The mean distance between the upper border of the tumor and esophago-gastric line was 2.7±1.2 cm. The most common procedure performed was wedge resection in six patients followed by eversion technique, intra-gastric approach (stapled resection) and proximal gastrectomy in one patient each. In two patients who underwent wedge resection, Toupet fundoplication was also performed. The median hospital stay was 3 days (range 1-5 days). The most common tumor risk stratification was low risk (4), followed by high risk (3) and intermediate risk (2). The median follow-up was 31 months (range 2-121 months). One of the patients presented with a solitary omental metastasis at one year four months follow-up which as resected following 3 months of imatinib therapy and showed myxoid degeneration. He is recurrence free at ten year follow-up. There was no evidence of recurrence in any other patient. The patient who underwent proximal gastrectomy had persistent reflux symptoms needing long term PPI therapy. Among the rest of the patients, only one patient who underwent wedge resection had mild reflux symptoms requiring intermittent PPI therapy.
Conclusion: Laparoscopic resection for GEJ GISTs is safe and feasible. The technique of resection utilized must be based on tumor factors and the surgeon’s experience.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94108
Program Number: P477
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster