Giant Gastrointestinal Stromal Tumor of the Stomach Treated by Proximal Gastrectomy with Esophagogastrostomy Using the Double-Flap Technique after: A Case Report

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  • Korai Takahiro
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Nobuoka Takayuki
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Ito Tatsuya
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Kyuno Daisuke
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Kanazawa Ayumi
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Nishidate Toshihiko
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Okita Kenji
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Nagayama Minoru
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Imamura Masafumi
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University
  • Takemasa Ichiro
    Department of Surgery, Surgical Oncology, and Science, Sapporo Medical University

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  • 噴門側胃切除後に食道残胃吻合にて再建した巨大胃gastrointestinal stromal tumorの1例

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Abstract

<p>We report a case treated with a reconstruction procedure using the double-flap technique (DFT) after proximal gastrectomy for removing a giant gastrointestinal stromal tumor (GIST) of the stomach. A 71-year-old woman presented with abdominal swelling. Clinical examinations revealed a large gastric GIST of 20 cm in diameter, located in the upper-middle portion of the stomach. Laparotomy with a vertical midline incision of the upper abdomen was performed, and a large tumor continuous with the posterior wall of the upper part of the stomach was found. Partial resection of the greater curvature of the stomach was attempted, including the base of the tumor. However, as the remnant stomach was narrowed, proximal gastrectomy was performed. DFT was selected as a reconstruction procedure to prevent postoperative reflux esophagitis and facilitate observation of the residual stomach. The postoperative clinical course was uneventful and the patient was discharged 14 days after surgery. The patient was in the high-risk category of the modified Fletcher classification, but she is alive without recurrence 16 months after surgery, with use of imatinib as adjuvant therapy. There were no symptoms of anastomotic stricture and reflux esophagitis after the surgery. Even for a large GIST, the basic principle of treatment is to minimize the extent of gastric resection. Therefore, for a large GIST of the upper stomach, where partial gastrectomy is difficult, proximal gastrectomy with reconstruction by DFT may be useful from the viewpoint of organ and function preservation and postoperative QOL.</p>

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