The Rare Upper Thoracic and Cervical Esophageal GIST Resected Through Thoracoscopic Esophageal Mobilization and a Cervical Approach: A Case Report

Abstract

Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm arising from the digestive tract; however, esophageal GIST is a very rare entity and represents < 1% of all GIST cases. Furthermore, esophageal GIST is most commonly located in the lower esophagus, while esophageal GIST in the upper esophagus is rare among them. Therefore there are very few reports regarding their resection methods.

Case: This report describes a very rare resectable case of large upper esophageal GIST that extended to the cervical esophagus to be completely resected by performing thoracoscopic mobilization of the esophagus, followed by transection of the cervical esophagus via a cervical approach. The operative procedure was as follows: ensuring an adequate macroscopic margin for esophageal resection from within the thoracic cavity was judged to be difficult; therefore, only dissection of the thoracic and cervical esophagus was performed with thoracoscopic procedure, and the cervical esophagus was resected via a cervical approach. The abdominal procedure was carried out laparoscopically, and the specimen, including the tumor, was extracted from a small incision. Next, reconstruction using a gastric tube via a retrosternal approach was done. We also describe a literature review of upper esophageal GISTs.

Conclusion: The surgical approach of large tumors of the upper thoracic and cervical esophageal GIST, including esophageal resection and reconstruction methods, needs to be carefully considered in advance. A cervical approach for esophageal resection is considered useful when it is difficult to resect the tumor's proximal end within the thoracic cavity safely.

Keywords: esophageal GIST; thoracoscopic surgery; upper thoracic esophagus.