Minimally Invasive Resection Techniques for Gastroesophageal Junction Gist Tumors

Introduction: Gastrointestinal Stromal Tumors (GIST) are relatively rare neoplasms of mesenchymal origin with uncertain malignant potential. Complete gross resection without a need for microscopically negative margins or lymph nodes is oncologically adequate. Minimally invasive resection techniques such as laparoscopic wedge gastectomy are feasible and safe. Unfortunately, GIST lesions located near the gastroesophageal junction can be quite difficult to resect using standard laparoscopic techniques. Several advanced options are available for completely excising these challenging lesions.
Methods: Two patients with GIST tumors located less than 1-cm from the gastroesophageal junction underwent minimally invasive resection. The first patient presented with a 3.5-cm submucosal mass consistent with a GIST tumor. Due to the slightly larger size of this lesion, a proximal gastrectomy using a Collis-Nissen esophageal lengthening technique was used. Laparoscopic staple lines were protected with a fundoplication utilizing the neo-fundus. The second patient presented with a 1-cm lesion at the gastroesophageal junction, also consistent with a GIST tumor. This lesion was excised using a trans-gastric endoluminal technique.
Results: Each lesion was completely excised and confirmed to be a GIST tumor on final examination. Pathology was favorable (

Session: Podium Video Presentation

Program Number: V031