Gabriela Chullo, Resident, Roser Termes, Resident, Ainitze Ibarzabal, Specialist, Dulce Momblan, Specialist, Victor Turrado, Specialist, Antonio Lacy, Specialist. Hospital Clinic de Barcelona
INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are considered a low malignancy tumors. The risk of recurrence is based on tumor size and mitotic index. Radical surgical resection is the standard treatment in localized primary GIST. Surgical margins of 10 mm free from tumor involvement are sufficient since surgical aggressiveness with wide margins of resection is not related to an increase in survival or decrease in the risk of relapse and, nevertheless, the involvement of the resection margins or simple enucleation of the tumor is subject to a high rate of relapse. GISTs rarely metastasize via the lymphatic system, so regional lymphadenectomy would not be necessary.
Laparoscopic resection has been increasingly adopted, being widely accepted as a reasonable approach to treat GIST with reported similar operative time and survival rates, but shorter hospital stay compared with open resection.
In this video we show a mid gastric resection and anastomosis of a gastric GIST.
METHODS AND PROCEDURES: We present the case of a 67-year-old female patient diagnosed in July 2017 with gastric GIST following abdominal discomfort and dyspepsia. The gastroscopy showed a mid-stomach lesion without ulceration or mucosal involvement. Computed tomography (CT) showed a submucosal gastric tumor, depending on the anterior wall of the gastric body. The tumor had a maximum diameter of 57 mm and suggested a GIST. No signs of dissemination were observed.
Endoscopic ultrasonography showed a well-defined, hypoechoic and heterogeneous lesion measuring 53 x 51mm in diameter and the ultrasound-guided needle biopsy confirmed GIST, positive immunohistochemical staining of CD117.
The patient received neoadjuvant treatment with Imatinib during 10 months, showing mild radiological response.
Laparoscopic resection in the mid-stomach was successfully performed. A side to side anastomosis was performed with manual suture .
RESULTS: The operation time was performed in 180 minutes, no intraoperative complications occurred, and clear fluid intake was started on the first post-operative day. The patient had an uneventful postoperative course, and a hospital stay of three days.
The histological result showed a 70x 50 x 40 mm tumor with low mitotic index and negative surgical margins.
The patient actually is asymptomatic and re-started the treatment with Imatinib.
CONCLUSIONS: In patients with resectable GIST, surgery continues to be the best treatment. Laparoscopic surgery is a safe and effective procedure, with excellent oncological results. Nevertheless, it is necessary to have experience in laparoscopic surgery to avoid tumor ruptures and minimize complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95234
Program Number: V251
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop