Surgical management of malignant gastric gist with organ sparing surgery

Abstract

Background: Gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours located commonly in the stomach. A complete and radical surgery is needed in most cases. GISTs near the gastro-esophageal junction are more challenging as compared to those situated in the pylorus, because of the complex surgical management. In our case we attempted an organ sparing surgery for a tumour located on the lesser curvature, which was close to cardia, thus avoiding a radical gastrectomy.Methods: A midline laparotomy followed by creation of a sleeve of the greater curvature was done. The cardio-oesophageal junction was divided and the tumour along with stomach adjacent to the lesser curvature resected using gastro-intestinal anastomotic linear staplers. Once vascularity of remnant stomach was confirmed, the greater curvature remnant was anastomosed to the oesophagus, thus restoring anatomic continuity.Results: Post-operative recovery was uneventful. A contrast study done on post-operative day 8 showed no leak. Patient was started on orals and was discharged on day 10 after adequate oral intake. Final histopathology report revealed a spindle cell GIST with resection margins and lymph nodes uninvolved. Immunohistochemistry study was positive for C-Kit and DOG-1 and negative for desmin and S-100. Tablet Imatinib was started and on a six month follow up patient showed no evidence of recurrence.Conclusions: GIST of lesser curvature close to cardia, can be treated with organ sparing surgery in selected patients, provided adequate tumour free resection margins and vascularity of remnant stomach is possible. It avoids a radical surgery and its associated complications.