Abstract
We report a case of gastrointestinal stromal tumor (GIST) located in the esophagogastric junction (EGJ), who was successfully treated with laparoscopic and endoscopic cooperative surgery (LECS). A 55-year-old man visited our hospital for further examination of a gastric submucosal tumor (SMT). Upper gastrointestinal scope and endoscopic ultrasonography revealed a gastric SMT, 20 mm in size, adjacent to the EGJ. The tumor was diagnosed as a GIST by an endoscopic fine-needle aspiration biopsy. We performed LECS with reduced port surgery, so called TANKO+1, with the intent to obtain a safe surgical margin, to avoid postoperative stricture of EGJ and to minimize the operative stress. The endoscopic procedure was utilized for mucosal and submucosal dissection, while the laparoscopic procedure was used for seromusclar dissection, thus the cut line was made appropriately and minimally. Finally, the whole layer of the stomach was perforated artificially by the ESD technique at the oral side of tumor and complete tumor removal was then accomplished by using a laparoscopic surgical device with secure hemostasis. The defect in the gastric wall was closed by a laparoscopic hand suture technique. Postoperative transillumination test showed no deformity of the stomach, stricture of the EGJ, nor gastroesophageal reflux. The patient left our hospital on postoperative day 7.
