Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 107002
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.107002
Gastric tube-guided and robot-assisted laparoscopic resection of gastroesophageal junction stromal tumors: Two case reports
Qiu-Ling Su, Shao-Lin Yuan, Peng Chen, Hao-Di Wang, Jiang Liu, Wei Jiang, Zhi-Wei Jiang, Hong-Shan Dai, Xin-Xin Liu
Qiu-Ling Su, Shao-Lin Yuan, Hao-Di Wang, Jiang Liu, Wei Jiang, Zhi-Wei Jiang, Hong-Shan Dai, Xin-Xin Liu, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Peng Chen, Department of Neurosurgery at Suzhou Hospital of Traditional Chinese Medicine, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215003, Jiangsu Province, China
Co-first authors: Qiu-Ling Su and Shao-Lin Yuan.
Co-corresponding authors: Hong-Shan Dai and Xin-Xin Liu.
Author contributions: Su QL and Yuan SL wrote edited the original draft; Chen P and Wang HD, Jiang W and Liu J provided a lot of help in the operation; Liu XX, Dai HS and Jiang ZW directed the writing of the manuscript; all authors have read and approved the final manuscript. Su QL and Yuan SL contribute equally to this study as co-first authors. Liu XX and Dai HS contribute equally to this study as co-corresponding authors. Dai HS, Chief Physician of General Surgery, has played a crucial role in our research and manuscript preparation. Specifically, Dai HS has offered professional guidance during the surgical procedures of the cases included in our study. His expertise has been particularly valuable in providing constructive suggestions on the key technical aspects of gastric tube-guided and robot-assisted laparoscopic surgery. In addition to his clinical contributions, Dai HS has also been actively involved in the academic aspects of our work. He has contributed to the writing of the treatment section of the manuscript and has provided professional advice on the improvement of intraoperative images. Furthermore, he has offered overall guidance and review throughout the manuscript writing process, significantly enhancing the quality of our paper. Liu XX has also made substantial contributions to our research and manuscript. Given the significant and equal contributions of both Dai HS and Liu XX to our research and manuscript, we propose to list them as co-corresponding authors.
Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine, No. MS2023017 and No. SLJ0311; and the Jiangsu Provincial Health Commission, No. ZDXK202251.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Xin Liu, MD, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China. yfy0055@njucm.edu.cn
Received: March 14, 2025
Revised: April 15, 2025
Accepted: May 21, 2025
Published online: July 27, 2025
Processing time: 132 Days and 23.4 Hours
Abstract
BACKGROUND

Gastroesophageal junction (GEJ) or gastrointestinal stromal tumor (GIST) are located in unfavorable parts of the stomach, due to the anatomical complexity of these regions, protecting the cardia while ensuring R0 resection is a major challenge for surgeons.

CASE SUMMARY

Two cases of GEJ stromal tumors were reported. Abdominal computed tomography scans revealed that both tumors were located at the GEJ, close to the posterior wall, with one tumor measuring greater than 5 cm. Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach. The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation. Postoperatively, no symptoms such as gastroesophageal reflux or cardia stenosis were observed. Case 1: Postoperative pathology: GIST. Immunohistochemical results: Tumor cells were positive for CD34, CD117, and DOG1, and negative for SMA, desmin, S-100, and SDHB (normal expression). The Ki-67 proliferation index was approximately 5%. Case 2: Postoperative pathology: GIST. Immunohistochemical results: Tumor cells were positive for CD117 (++), CD34 (++), DOG1 (+++), and focal positivity for SMA. Negative for desmin, S-100 (few cells positive), and SDHB (preserved expression). The Ki-67 proliferation index was approximately 10%.

CONCLUSION

The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia, and it is worth further promotion in clinical practice.

Keywords: Gastrointestinal stromal tumour; Gastroesophageal junction; Wedge resection; Gastric tube; Laparoscopy; robotic surgery; Case report

Core Tip: Protecting the cardia is a considerable challenge in the surgical management of esophagogastric junction gastrointestinal (GI) stromal tumors. This study aims to investigate and summarize the application value of gastrostomy-guided and robot-assisted techniques in safeguarding the cardia during the resection of GI stromal tumors situated in anatomically unfavorable gastric locations.