Esophagogastric Reconstruction in Cobra-Head Shape with Toupet-Like Partial Anti-Reflux Technique for Resection of Proximal Gastric Tumors. Experience with Three Cases from a Non-Asian Population
Background: Proximal gastrectomy is a rarely performed procedure but a feasible option in benign tumors and malignant neoplasms in the proximal third of the stomach since novel options of reconstructions are available nowadays with fewer long-term sequels. Methods: Report of three cases of proximal gastric gastrointestinal stromal tumors (GIST), with a description of its presentation, histological characteristics, and follow-up after being treated with proximal gastrectomy with cobra head reconstruction. Results: Case 1: A 62-year-old woman with epigastric pain of four months with endoscopic evidence of a cardia GIST. The surgery was performed without complications. The histopathological report confirmed a fusiform GIST of 3.2 × 3 × 2.5 cm, stage IA. No adjuvant treatment was considered. An esophagogram showed no evidence of reflux and no stenosis, and no disease recurrence after 40-months follow-up. Case 2: A 66-year-old woman with dyspepsia and a palpable tumor in the epigastrium. The surgery was performed without complications. The pathology report confirmed a proximal gastric GIST of 13 × 8 × 7 cm, staged II. She received adjuvant treatment with imatinib for 36 months without recurrence and no reflux or stenosis. Case 3: A 55-year-old woman with intermittent hematemesis and right subscapular pain. The surgery was performed without complications. The histopathological report concluded that a GIST tumor of the cardia, 1.4 × 1.2 cm, staged IA. She was left in observation. At a 6-month follow-up, she does not report dysphagia, reflux, or stenosis, and no locoregional recurrence. Conclusions: Open and laparoscopic proximal gastrectomy is a safe therapeutic option for GIST. Furthermore, the reconstruction of the esophagus-gastro anastomosis in the cobra head after proximal gastrectomy is feasible and secure in our population, with good functional results in a short follow-up.
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