Two Cases of Esophageal GIST Thoracoscopically Resected Attaching the Intrincis Muscle Layer to the Tumor for Secure Resection Margins and Preserving Esophageal Mucosa

Abstract

Primary esophageal gastrointestinal stromal tumor (GIST) is a rare neoplasm, and the most reliable treatment is surgical resection without capsular damage. Thoracoscopic ‘enucleations' for low-risk esophageal GISTs have recently been reported, however, a question whether the tumor ‘enucleation' assures an enough tumor resection margin remains unresolved.

We performed thoracoscopic tumor resection for two cases of esophageal GIST. In both cases esophageal tumors were found incidentally, and endoscopic biopsy revealed preoperative diagnosis of low-grade GISTs. Tumor resections with esophageal muscularis propria attached to the tumor capsule for secure resection margins, rather than tumor ‘enucleations', were performed even with preserving the esophageal mucosal layer. Although the esophageal tissue defect of the tumor resection would be larger than that of the tumor ‘enucleation', suture closure was possible without causing mucosal damage or constriction of the esophageal lumen.

An esophagectomy accompanied by reconstruction is considered to be over-invasive for low-grade esophageal GISTs, whereas a tumor ‘enucleation' is less invasive but could make the resection margin inadequate. Our esophageal tumor resection procedure with dissecting the intrinsic muscle layer is a safe procedure and ensures an adequate resection margin.