Combined Laparoscopic Intragastric Stapled Resection with Endoscopic Mucosal Resection Technique for the Gastric Gastrointestinal Stromal Tumor Localized in Cardia

Introduction:

Neoplastic tumors localized close to the gastroesophageal (GE) junction are often a challenge both for the surgeon and the patient. ¹ The procedure is usually connected with extensive resection of stomach and part of the esophagus. It is fully justified for cancer treatment with the necessity of regional lymphadenectomy. In the case of primary gastrointestinal stromal tumors (GISTs), standard surgical treatment is based on local excision. ^{2 –4} In the video, we present our modification of intragastric resection of GIST combining laparoscopic stapled resection with endoscopic mucosal resection, which leads to an effective en block resection of the GIST in a difficult localization.

Materials and Methods:

An 81-year-old female was qualified for the surgical treatment of the 3 cm cardia GIST. An asymptomatic tumor was diagnosed during the routine gastroscopy. A preoperative CT scan confirmed that there were no metastases to the liver and that the tumor was limited to the stomach wall. In the video, we present a novel variant of minimally invasive approach for this kind of tumor—a combination of laparoscopic and advanced endoscopic methods. During intraoperative gastroscopy, the presence of GIST localized close to the GE junction was confirmed. The base of the tumor was stapled. The remaining part of the mucosa between the tumor and stomach wall was removed using the mucosectomy technique. The specimen was retrieved through the mouth.

Results:

There were no intra- and postoperative complications. The pathological report confirmed R0 resection of CD117-positive GIST with MI 4/50 high power field. ⁵ In the follow-up CT scan and gastroscopy after 3 months, we did not find a recurrent tumor.

Conclusion:

We strongly believe that laparoscopic intragastric stapled resection has the potency to become a standard procedure for the treatment of GISTs localized near the GE junction. In the enclosed video, we showed that in the case of a wide base of the tumor, our modification—a combination of stapling and mucosectomy—is a valuable alternative.

No competing financial interests exist.

Runtime of video: 5 mins 51 secs