LAPAROSCOPIC MANAGEMENT OF LARGE GASTRIC MESENCHYMAL TUMORS IN THE FUNDUS ADJACENT TO THE CARDIA WITH CONCOMITANT ANTI-REFLUX RECONSTRUCTION: A REPORT OF TWO CASES
Main Article Content
Abstract
Background: Gastric mesenchymal tumors, among which gastrointestinal stromal tumors (GISTs) are the most common, are primarily treated by complete surgical resection with negative margins. Laparoscopic surgery has been increasingly adopted due to its safety and effectiveness. However, large tumors located at the gastric fundus near the cardia remain challenging because of the difficulty in achieving oncologic clearance and the risk of cardia stenosis and postoperative gastroesophageal reflux. The role of anti-reflux procedures in this setting remains unclear.
Objective: To report the outcomes of laparoscopic resection combined with anti-reflux reconstruction in the management of large gastric mesenchymal tumors located at the fundus near the cardia.
Methods: This is a retrospective case series of two patients with large gastric mesenchymal tumors at the fundus near the cardia who underwent laparoscopic resection combined with anti-reflux reconstruction at Tam Anh Hospital between 2024 and 2025.
Results: Both patients underwent successful laparoscopic resection with negative margins (R0) combined with Dor fundoplication. Tumor sizes were 38 × 35 x 22 mm and 72 × 57 x 55 mm; operative times were 140 and 220 minutes; oral intake was resumed on postoperative days 3 and 5, respectively. Histopathology revealed one leiomyoma and one GIST (risk group 3a). No intraoperative or postoperative complications were observed. At 6-month follow-up, no cardia stenosis or reflux symptoms were reported.
Conclusion: Laparoscopic resection combined with Dor fundoplication is a feasible, safe approach for the management of large gastric mesenchymal tumors located in the fundus adjacent to the gastroesophageal junction, ensuring oncologic principles while preserving anti-reflux function.
Keywords
Gastric mesenchymal tumor, GIST, laparoscopic surgery, Dor fundoplication
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References
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