Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases.

Abstract

Title: Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases. Introduction: Gastrointestinal stromal tumor is the most common mesenchymal tumor of gastrointestinal tract. Surgery is the cornerstone of management. Targeted chemotherapy viz. Imatinib, sunitinib, regorafenib had reported to be useful in locally advanced cases for downstaging. Here we are presenting two cases, one was arising from the stomach another from tail of the pancreas. Both were successfully managed by laparoscopic multivisceral resection of gastrointestinal stromal tumor after downstaging of tumors. Case report 1: A 47 years old male presented with postprandial fullness and early satiety for 8 months associated with on an off episode of melena. His general, physical and abdominal examination was unremarkable. Endoscopy revealed, normal gastric mucosa with an extrinsic bulge. USG abdomen and CECT revealed a heterogeneously enhancing lesion probably arising from the greater curvature of the stomach and abutting spleen and pancreas. Neoadjuvant therapy started in view of locally advanced disease. He underwent laparoscopic sleeve resection of gastric GIST with distal pancreatico-splenectomy. After a year follow up, no signs of recurrence seen. Case report 2: A 64 years old male presented with dyspepsia and postprandial fullness for 2 years with no history of melena. He also had a loss of appetite and weight. UGI endoscopy revealed extrinsic compression with normal mucosa. USG abdomen and CECT revealed a 17.2 x 11 x 10.5 cm solid cystic lesion abutting greater curvature of the stomach and extending up to splenic hilum and effacing pancreas. In view of locally advanced disease he received imatinib for 1 year followed by laparoscopic distal pancreaticosplenectomy. On six months follow up he is doing well. Conclusion: Gastrointestinal stromal tumor is a rare mesenchymal tumor that has metastatic potential. Open surgery is the preferred view to avoid spill and positive resection margins. Here both patients were managed by multivisceral resection, laparoscopically. Though there is a dearth of literature regarding laparoscopic surgery. However, it is feasible in experienced hands.