Piotr Gorecki, MD, Tianming Liu, MD, MPH. New York Methodist Hospital
Background: Gastrointestinal stromal tumors (GISTs) are generally solitary tumors. Multiple synchronous GISTs are rare, found in 1% to 2% of all GISTs. In general, surgical management remains similar to that of solitary GISTs. The size and location of the tumor determines the surgical approach: wedge gastric resection or segmental resection with margins free of tumor. Few cases of laparoscopic sleeve gastrectomy (LSG) for the resection of gastric GISTs have been reported. Here, we present a case of sporadic synchronous giant gastric GISTs resected with formal LSG.
Case presentation: A 51-year-old female with type II diabetes and BMI of 35 kg/m2 was found to have a single gastric mass on upper endoscopy during the work up for chronic anemia. A contrast computed tomography scan demonstrated two exophytic, smooth, heterogeneous gastric lesions, 6.1 x 7.1 x 7.7 cm in the posterior aspect of mid body and 5.7 x 5.4 x 6.1 cm in the anterior aspect of the gastric antrum. There was no radiographic evidence of metastases or local invasion. Results of fine needle aspirations show both tumors consisted of spindle cells and were CD117 positive, consistent with GIST. The patient underwent successful resection of both tumors via formal LSG over 36 F Bougie, with wide margins. Post-operative recovery was uneventful. Final pathology revealed two high histologic grade (mitotic rate 5-6/50 HPF) spindle cell GISTs. The resection margins were negative with 0.7 cm at the closest margin. At 6-month follow up, patient has lost 15 pounds with a BMI of 31.5 kg/m2. Diabetes was well controlled with HbA1c of 5.6, decreased from 6.6 pre-operatively. At one-year follow up, tumor surveillance shows no recurrence. Patient has lost an additional 4 pounds with a BMI of 30.8 kg/m2.
Conclusion: LSG appears to be the optimal anatomic, technical and functional choice for resection of multiple gastric GISTs. Potential advantages include decreased staple line angulation and distortion, and increased resection margin. Additional benefits of metabolic improvement and weight loss are desirable for patients who are overweight or suffer from metabolic syndrome, as in this case. The anatomy, location, BMI, and metabolic parameters should all be considered prior to gastric resection for GISTs. In the experienced hands and appropriate clinical setting, this approach can be extended to the management of solitary gastric GISTs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77807
Program Number: V014
Presentation Session: Gastric
Presentation Type: Video