Laparoscopic Transgastric Resection Approaches for Gastrointestinal Stromal Tumors Located in Gastroesophageal Junction

Nicolasa Fernandez Soria, Alejandra Garcia Novoa, Namibia Sanluis Verdes, Sergio Builes Ramirez, Maria Jesus Garcia Brao, Pablo Concheiro Coello, Jose Francisco Noguera, MD, PhD. Hospital Universitario de A Coruna

INTRODUCTION. Gastric submucosal tumors are rare, being gastrointestinal stromal tumor (GIST) the most common finding. Surgical wedge resection without lymphadenectomy is the first choice of treatment. Minimally invasive techniques like combined transgastric and endoscopy approach are useful in tumors located near gastroesophageal junction, avoiding risk of stenosis.

PATIENTS AND METHODS. We present two cases of  GIST located near the gastroesophageal junction underwent laparoscopic transgastric resection at our institution. The first case was 41-year-old male evaluated by gastroenterology for dyspepsia founding in upper endoscopy a 2cm submucosal lesion located in the gastric fundus, with anatomopathology result of GIST. This was accomplished using four trocars. The first one was used like usual laparoscopic approach. The other three were placed intragastric directly through the abdominal wall under laparocospic view. The resection was made with an endoscopic linear staples.

The second case is about a 3cm GIST in the gastroesophageal junction diagnosed in a 61-year-old male. The surgical technique performed was similar to previous case. Due to the proximity of the tumor to gastroesophageal junction and the incidental gastric perforation due to the use of the harmonic scalpel this case required endoscopic assistance to the suture.

RESULTS. Postoperative evolution was uneventful, the first patient was discharged on postoperative day 5 and the other on day 7. The definitive anatomopathologie results confirm the histology (GIST) and tumor-free margin.

CONCLUSION. Laparoscopic transgastric resection, with or eithout endoscopic assistance, is possible and safe, with satisfactory clinicopathologycal results, specially in submucosal tumor located near to the gastro-esophageal junction. 

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