Robotic Esophagogastric Resection for EGJ GIST and Intrathoracic Esophagogastric Anastomoses with Luminal Apposing Metal Stent.

Abstract

Luminal apposing metal stent (LAMS) has been used to create endoscopic large-caliber communications between different organs.¹ LAMS has an anti-migration design. Dilation is progressive and does not cause ischemia or inflammation. There is no tissue loss, as with stapled anastomosis, we do not have any intercepting staple line.^2-7 Being coated allows for early refeeding. The aim of this study was to assess the preliminary results of the use of the LAMS in surgical gastrointestinal anastomoses. An 82-year-old patient underwent robotic proximal esophagogastric resection for bulky esophagogastric junction (EGJ) gastrointestinal stromal tumors (GIST) and intrathoracic esophagogastric anastomoses with LAMS. Lumen diameter used was 20 mm. The patient could not undergo neoadjuvant treatments because the lesion was bleeding. Proximal gastrectomy is a valuable option for selected patients with GISTs of the gastric fundus or EGJ. It offers excellent oncologic results with superior functional outcomes compared to total gastrectomy.^8-11 To our knowledge, this is the first report in the world to use this technique. Operative time was 180 min and hospital stay was 7 days. We did not record any perioperative surgical complications even after stent removal. The final histology showed a GIST pT4 N0 M0. At the 6-month follow-up we did not record any symptoms of reflux or signs of stenosis. The patient has a good nutritional status. Our preliminary experience shows that this approach is feasible and safe. It could become the new standard of care and reduce the risk of anastomotic leakage in at-risk anastomoses. Randomized controlled trials in large populations are needed.