Bengaluru, Nov 12: A 74-year-old man diagnosed with a rare tumour in the lower part of his food pipe has undergone complex robotic surgery at Apollo Hospitals, Bengaluru. The tumour’s location required surgeons to remove the affected section of the oesophagus and reconstruct the food passage using his stomach. He is recovering well and remains under multidisciplinary follow-up.
The patient had sought medical attention after experiencing difficulty swallowingfor four months. Medical tests revealed a 5-cm gastrointestinal stromal tumour in the lower oesophagus. These tumours usually arise in the stomach or small intestine, while their occurrence in the oesophagus is particularly uncommon.
The challenge was not simply removing the tumour. The approximately 5-cm tumour involved around 50% of the oesophageal circumference, making a more limited local resection technically unsuitable and making it difficult to obtain adequate negative margins. A formal oesophageal resection with reconstruction was therefore required to achieve an appropriate oncological resection while restoring the continuity of the food passage.
Before proceeding, doctors assessed the patient’s fitness for major surgery and planned his anaesthetic care, nutrition and postoperative support. He had underlying cardiac comorbidities and had become nutritionally depleted following several months of difficulty swallowing. He was also an ex-smoker, factors that were taken into consideration during preoperative assessment and postoperative planning. Following multidisciplinary review, the team performed a robotic Ivor Lewis oesophago-gastrectomy.
The operation involved both abdominal and chest phases. Surgeons removed the tumour-bearing portion of the oesophagus and the adjoining proximal stomach as required, then used the stomach to create a new food passage and connected it to the remaining oesophagus.
The robotic approach allowed the surgeon to work through small incisions, using a three-dimensional view and articulated instruments to assist with precise dissection and reconstruction.
Speaking about the case, Dr. Suraj Manjunath, Senior Consultant – Surgical Oncology, Apollo Hospitals, Bengaluru, said:
“Oesophageal GIST is an extremely uncommon tumour, and operating in the lower oesophagus presents unique technical challenges. An Ivor Lewis procedure is itself a major operation, and in this patient, we were able to perform the entire resection and reconstruction using a robotic minimally invasive approach. The enhanced visualisation and instrument articulation provided by the robotic system were particularly useful during the thoracic and reconstructive portions of the procedure.”
Care extended beyond the operation, with surgical oncology, anaesthesia, critical care, gastroenterology, radiology, pathology, nutrition and rehabilitation teams supporting the patient’s treatment and recovery.
Following surgery, the patient developed breathing difficulties related to atelectasis, which were managed conservatively. At his latest review, he was eating well, was active and independent in his daily activities, and was gradually regaining the weight he had lost during his illness.
The final pathology confirmed a 5.2 × 4.5 × 4.0-cm gastrointestinal stromal tumour of spindle-cell type arising in the lower oesophagus. The tumour was high grade, with more than five mitoses per 5 mm², and was classified as high risk. All examined proximal, distal, radial and adventitial resection margins were free of tumour. No metastatic disease was identified in the 11 lymph nodes examined. The pathological stage was pT3N0 according to the AJCC 8th edition.
Unlike the more common cancers of the oesophagus, GISTs have distinct biological and molecular characteristics. Treatment depends on the tumour’s size, location, mitotic activity, pathology and molecular profile. Surgery is an important treatment for selected patients with localised, resectable disease, while targeted medicines may be appropriate depending on the tumour’s molecular characteristics and clinical circumstances.
Further treatment and surveillance for this patient will be guided by the final immunohistochemical and molecular characterisation of the tumour, together with the pathological risk assessment. His team will continue to monitor his recovery, particularly his nutritional status, weight and ability to eat normally.
