LSG for gastric leiomyosarcoma in MO patient: A case for collaboration

Osama Hamed, MBBS, Ajay Jain, MD, Mark Kligman, MD. Department of General Surgery, University of Maryland School of Medicine, Baltimore MD


Objective: Minimally Invasive Surgery (MIS) for Gastrointestinal (GI) malignancies had gained large attention recently, the plethora of information available on the internet resulted in patients expectation to have their elective cancer surgery done laparoscopically. MIS for GI malignancy require advanced laparoscopic skills mastered by Minimally Invasive Surgeons, at the same time adherent to the principles of surgical oncology and multidisciplinary approach mastered by Surgical Oncologists.
Methods: 49 year old male, presented with epigastric pain of several months duration. Upper GI endoscopy showed an ulcerated mass in the Gastric Fundus within 3 – 4 cm of the Gastroesophageal Junction. Biopsy demonstrated gastric leiomyosarcoma. The patient was morbidly obese with BMI of 44.2 kg/m2. Multidisciplinary oncology team decision made for resection with negative margin as the best treatment option. Patient seen by surgical oncology and requested surgery to be done laparoscopically. Due to patient body habitus, complex nature of the procedure and the possible need for complex laparoscopic GI reconstruction, patient was referred to MIS/Bariatric surgery team for evaluation, preoperative planning and collaboration. During this evaluation the patient expressed a desire for weight loss; sleeve gastrectomy was determined to be the best option to achieve the patient’s goal of weight loss while still maintaining the oncologic principles.
Results: Laparoscopic exploration in the presence of both the MIS and the surgical oncologist, confirmed that sleeve gastrectomy was an adequate procedure to provide the desired negative margin. The procedure was completed without complication. Patient was discharged home on post operative day 1. Pathology showed high grade gastric leiomyosarcoma, 3.8 cm margin from the staple line. The patient had a 44% excess weight loss (67 Ibs) 5 months post operatively. Multidisciplinary oncology decision made for close follow up with no need for adjuvant therapy. Patient was greatly satisfied with the surgical approach and the outcomes.
Conclusion: Minimally invasive management of GI malignancies represents a challenge for both surgical oncologist and MIS as individual surgeon. Collaboration among the two specialties needed to provide the optimal care for patients.

Session Number: Poster – Poster Presentations
Program Number: P521
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