Laparoscopic resection for a large gastrointestinal stromal tumor (GIST) with diaphragm invasion following preoperative imatinib treatment: A case report

• Published in: International journal of surgery case reports Vol. 81; p. 105727
• Main Authors: Yoshioka, Shoko, Tazawa, Hirofumi, Saito, Akihisa, Komo, Toshiaki, Sada, Haruki, Hadano, Naoto, Shimada, Norimitsu, Onoe, Takashi, Sudo, Takashi, Shimizu, Yosuke, Kuraoka, Kazuya, Suzuki, Takahisa, Tashiro, Hirotaka
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-04-2021; Elsevier
• Subjects: Case Report; Laparoscopic resection; Large gastric GIST invading diaphragm; Neoadjuvant imatinib; 18F-FDG PET; PBT; Large gastric GIST invading diaphragm; UGI; GISTs; Laparoscopic resection; Neoadjuvant imatinib; EUS-FNA; SMTs
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.105727

•We experienced successful treatment for large GIST with diaphragm invasion by a combination of preoperative imatinib treatment and laparoscopic resection.•In the neoadjuvant imatinib, it is important to indicate cases and mediate the duration.•The most important point for laparoscopic resection of large GIST is how to handle it.
Neoadjuvant imatinib for large GISTs may prevent tumor rupture and the need for extended surgery by reducing tumor size. In this study, we present a case of large gastric GIST with diaphragm invasion, due to the patient receiving laparoscopic resection following preoperative imatinib treatment.
A 72-year-old woman was hospitalized with left hypochondriac pain for a month. Examinations revealed a large heterogeneous gastric mass measuring 80 mm in size, arising from the greater curvature of the corpus. The mass invaded the left thoracic diaphragm. Treatment with imatinib at an initial dosage of 400 mg/day was initiated. After a further two months of follow-up, the lesion had sustained reduction to 50 mm in size, however, the invasion to the diaphragm remained. The patient eventually underwent laparoscopic partial gastrectomy and partial resection of the diaphragm with curative intent. Adjuvant chemotherapy was initiated at one month after the surgery, however, was discontinued due to nausea. After one-year follow-up, no recurrence was noted.
Neoadjuvant imatinib may shrink tumor size remarkably and prevent tumor rupture during surgery, and thus lead to increased rates of complete resection. To date, several publications have directly compared the oncologic results between laparoscopic and open resection for GISTs. In the present case, the tumor was movable, and moderately fixed on diaphragm. It was favorable condition for laparoscopic surgery.
This is the first report of a large gastric GIST invading the diaphragm that was successfully treated by laparoscopic resection after tumor reduction by neoadjuvant imatinib.