Introduction:Stromal cell tumors comprise only 1% of all primary gastric neoplasms despite being the most common nonepithelial tumors involving the gastrointestinal tract. On rare occasions these tumors present at the esophagogastric junction (EGJ). This tumor location represents a unique disease presentation and technically, a surgical challenge. The goal of this study is to characterize the presenting symptoms, pre-operative diagnosis and surgical management of gastric stromal neoplasms occurring at the gastroesophageal junction.
Materials and Methods: Retrospective review of gastroesophageal junction stromal neoplasms resected at a single institution from 1995-2006. Medical records were reviewed with respect to patient demographics, presenting symptoms, pre-operative diagnosis, surgical approach, length of hospital stay, and overall results.
Results:From 1995-2006, a total of 30 patients (19 male and 11 female) with a median age of 56 years underwent resection of an EGJ stromal tumor. All were symptomatic. Reflux and dysphagia were the two most common presenting complaints. Eighteen patients (60%) were taking either H2 blockers or proton pump inhibitors. Surgical procedure included enucleation in 22 (73%), resection with primary repair in 4 (13%), and esophagogastrectomy in 4 (13%). Approach was laparotomy in 10 (33%), laparoscopy in 8 (27%), left thoracotomy in 7 (23%), laparotomy with right thoracotomy 3 (10%), and thoracoabdominal in 2 (7%). Additional procedures included fundoplication in 16 (53%) patients: 2 Belsey Mark IV, 2 partial posterior fundoplications, 5 partial anterior fundoplications, and 7 Nissen fundoplications. Pathological findings included leiomyoma in 21 (70%), gastrointestinal stromal tumors in 6 (20%), leiomyosarcoma in 2 (7%), and inflammatory fibroid polyp with stromal tissue in 1 (3%). The median hospital stay was 6 days. Overall complication rate was 20% (5 of 22 open resections and 1 of 8 laparoscopic resections), and there were no deaths. One patient was treated with adjuvant therapy. Median follow-up was 11 months. There were 2 systemic recurrences of leiomyosarcoma. Three patients (10%) have reflux requiring medical therapy and 2 (7%) complain of bloating.
Conclusions:EGJ stromal tumors are rare and often presents with a distinct set of clinical findings. Surgical resection is the optimal treatment and the approach should be tailored to the individual patient.