Gastric tube-guided and robot-assisted laparoscopic resection of gastroesophageal junction stromal tumors: Two case reports.

BACKGROUND

Gastroesophageal junction (GEJ) or gastrointestinal stromal tumor (GIST) are located in unfavorable parts of the stomach, due to the anatomical complexity of these regions, protecting the cardia while ensuring R0 resection is a major challenge for surgeons.

CASE SUMMARY: Two cases of GEJ stromal tumors were reported. Abdominal computed tomography scans revealed that both tumors were located at the GEJ, close to the posterior wall, with one tumor measuring greater than 5 cm. Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach. The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation. Postoperatively, no symptoms such as gastroesophageal reflux or cardia stenosis were observed. Case 1: Postoperative pathology: GIST. Immunohistochemical results: Tumor cells were positive for CD34, CD117, and DOG1, and negative for SMA, desmin, S-100, and SDHB (normal expression). The Ki-67 proliferation index was approximately 5%. Case 2: Postoperative pathology: GIST. Immunohistochemical results: Tumor cells were positive for CD117 (++), CD34 (++), DOG1 (+++), and focal positivity for SMA. Negative for desmin, S-100 (few cells positive), and SDHB (preserved expression). The Ki-67 proliferation index was approximately 10%.

CONCLUSION

The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia, and it is worth further promotion in clinical practice.