In a recent case report published in the International Journal of Surgery Case Reports, Yamamoto et al concluded that robotic-assisted minimally invasive esophagectomy (RAMIE) allowed for safe and minimally invasive resection of an esophageal gastrointestinal stromal tumor (GIST).

The duration of the surgery was 319 minutes, with the thoracoscopic portion taking 69 minutes. The patient, a 60-year-old woman diagnosed with a 30-mm GIST in the middle thoracic esophagus, lost 135 mL of blood during the procedure. No postoperative events were registered, and the patient was discharged home 18 days after surgery in good condition.

The patient has been followed up every 3 months, and no recurrence was observed in the 50 months after surgery. Pathological analysis of the tumor confirmed low-risk GIST, which did not require adjuvant therapy.


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“Macroscopically, the tumor was a well-circumscribed gray-white fibrous mass involving the submucosa and the muscular layers and sparing the mucosa of the esophagus, 4.3×4.3×2.7 cm in size,” Yamamoto et al wrote.

On histopathological analysis, they observed spindle-shaped cells with a spindle-shaped nucleus and pale eosinophilic vesicle growing in an intricate manner. The proliferation rate was 2% to 3%. The cells stained for KIT and CD34 but not for pS100 or desmin.

Esophageal GIST is rare (less than 1% of all GISTs). According to the study authors, “complete surgical resection is the standard of treatment for esophageal GIST because of malignant potential. But there is no standard technique due to the anatomical peculiarity of the esophagus.”

Therefore, RAMIE may be a promising surgical option for treating esophageal GIST due to the need to operate in such a limited space in the thoracic cavity.

Reference

Yamamoto H, Ebihara Y, Tanaka K, et al. Robot-assisted thoracoscopic esophagectomy for gastrointestinal stromal tumor of the esophagus: a case report. Int J Surg Case Rep. Published online August 26, 2021. doi:10.1016/j.ijscr.2021.106335