Robot-assisted thoracoscopic esophagectomy for gastrointestinal stromal tumor of the esophagus: A case report

Abstract

Introduction: A gastrointestinal stromal tumor (GIST) often arises in the stomach and small intestine, while esophageal GIST is rare. The first-choice treatment is surgical resection, but there is no standard technique. Herein, we describe our experience in the treatment of esophageal GIST and discuss the usefulness of robotic esophagectomy.

Presentation of case: The patient was a 60-year-old woman, who was diagnosed with a 30 mm GIST in the middle thoracic esophagus. We underwent robot-assisted thoracoscopic esophagectomy in the prone position. The duration of the thoracoscopic part was 69 min and the total operation time was 319 min. Total blood loss was 135 ml. The patient's postoperative course was uneventful after surgery and the patient was discharged home in good condition on the 18th postoperative day.

Discussion: The prognosis of esophageal GIST was less favorable compared with gastric GIST, and due to the anatomical peculiarities of the esophagus, which surgical procedure should be performed is still under debate. Robotic surgery has several technological advantages as it provides a three-dimensional view, ten times magnification, tremor control, and ambidexterity. Therefore, Robotic-assisted minimally invasive esophagectomy (RAMIE) allows achieving for safe R0 resection of esophageal GIST.

Conclusion: RAMIE may be useful for esophageal GIST because it facilitates safe and minimally invasive surgery in a limited space of the thoracic cavity.

Keywords: Esophageal gastrointestinal stromal tumor; Esophagectomy; Minimally invasive; Robotic surgery.

Fig. 1

(a) Upper gastrointestinal endoscopy showed a protruded lesion covered with normal mucosa in 28–34 cm from the incisor teeth. (b) Subsequent EUS demonstrated a hypoechoic, homogeneous tumor 3.1 × 2.7 cm in size, arising from the muscular mucosae.

Fig. 2

(a) CT scan showed the tumor with heterogeneous density and no metastasis in the lung and the liver. (b) Positron Emission Tomography CT revealed SUVmax 9.67 in the mediastinum on the right side of the esophagus.

Fig. 3

The port placement. (a) Thoracoscopic phase. (b) Laparoscopic phase.

Fig. 4

Intraoperative findings. (a) The operative field was ensured because the collapsed lung is drawn ventrally by gravity. (b) The esophagus was lifted by a vessel tape and divided at the tracheal bifurcation by the Stapler. T, tumor; L, lung; TV, thoracic vertebrae; RB, right main bronchus.

Fig. 5

Pathological findings. (a) The tumor was 4.3 × 4.3 × 2.7 cm in size. (b) Spindle-shaped cells were growing in an intricate manner (magnification, ×200).