P1.189. A Case of Laparoscopy-Assisted Distal Esophagectomy for a 6.5-cm Esophageal Gastrointestinal Stromal Tumor

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Case Submission (GISTs) are extremely rare and account for less than 1% of all GISTs. Their clinical behavior, optimal surgical approach, and postoperative management remain unclear due to limited reported cases. Rapid tumor growth may indicate aggressive biological potential and increased risk of recurrence. Early diagnosis and appropriate treatment are therefore essential. We report a case of rapidly growing esophageal GIST successfully treated with laparoscopy-assisted distal esophagectomy and adjuvant treatment. Methods A 67-year-old man was referred to our hospital for evaluation of a rapidly enlarging submucosal tumor in the distal esophagus. Clinical data, endoscopic findings, imaging studies, and pathological results were performed in the previous hospital. Tumor progression was monitored using serial upper gastrointestinal endoscopy. Endoscopic ultrasound-guided fine-needle aspiration was performed for histological diagnosis. Surgical outcomes, postoperative course, adjuvant therapy, and long-term follow-up data were evaluated. Results Initial endoscopy revealed a 1.5-cm submucosal tumor in the distal esophagus, which increased to 7-cm within 10 months and developed ulceration. EUS-FNA demonstrated positivity for c-kit, CD34, and DOG1, confirming esophageal GIST. No distant metastases were detected. We performed laparoscopy-assisted distal esophagectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 17. the tumor was classified as high risk according to the modified Fletcher criteria. Adjuvant imatinib therapy was initiated for three years and completed. Four years after surgery, local recurrence, pleural and peritoneal dissemination were detected. Imatinib therapy was reinitiated, resulting in sustained disease control. Conclusion Rapidly growing esophageal GISTs may exhibit aggressive clinical behavior and require careful long-term surveillance, even after complete surgical resection and adjuvant therapy. Accurate diagnosis using EUS-FNA and appropriate surgical intervention are essential for optimal management. Laparoscopy-assisted distal esophagectomy is a feasible minimally invasive approach in selected patients. Although recurrence may occur several years after treatment, reinitiation of imatinib therapy can achieve sustained disease control. This case highlights the importance of multidisciplinary management and prolonged follow-up in patients with high-risk esophageal GISTs.