Total laparoscopic resection of giant multi-lobulated gastrointestinal stromal tumour of stomach: a case and literature review

Abstract

: Laparoscopic resection is being increasingly used in the management of gastric gastrointestinal stromal tumours (GISTs) despite having some oncological safety concerns. Tumour size is an important determinant and laparotomy may be required for larger tumours. The role of laparoscopic resection for large GISTs especially with more than 5 cm size is debatable. This is mainly due to the possibility of intraoperative tumour rupture leading to high recurrence rates. Here we present a case report of 52-year-old obese female presented with left sided upper abdominal discomfort and early satiety for 3 months duration. She also had a recent episode of upper gastrointestinal bleeding. Upper gastrointestinal endoscopy and computed tomography scan of the abdomen revealed a giant gastric (12×11×9 cm3) GIST. She underwent total laparoscopic resection without tumour rupture. Histology revealed complete resection margins without malignant changes. She had adjuvant treatment with Imatinib considering tumour size, higher mitotic count and was well throughout the course of treatment. She is asymptomatic on long term follow up. Laparoscopic excision is feasible for removal of a giant gastric GIST in experienced hands.