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Open Access Highly Accessed Case report

The Merendino procedure following preoperative imatinib mesylate for locally advanced gastrointestinal stromal tumor of the esophagogastric junction

Wilko I Staiger1, Ulrich Ronellenfitsch1, Georg Kaehler1, Hans Ulrich Schildhaus2, Antonia Dimitrakopoulou-Strauss3, Matthias HM Schwarzbach1 and Peter Hohenberger1*

Author Affiliations

1 Div. Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany

2 Department of Pathology, University of Bonn Medical School, Germany

3 Medical PET Group – Biological Imaging, Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany

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World Journal of Surgical Oncology 2008, 6:37  doi:10.1186/1477-7819-6-37

Published: 4 April 2008

Abstract

Background

Gastrointestinal stromal tumors (GIST) of the esophagogastric junction might pose a major problem to surgical resection. If locally advanced, extended or multivisceral resection with relevant procedural-specific morbidity and mortality is often necessary.

Case presentation

We report a case of a patient with a locally advanced GIST of the esophagogastric junction who was treated by transhiatal resection of the lower esophagus and gastric cardia with reconstruction by interposition of segment of the jejunum (Merendino procedure). Prior to resection, downsizing of the tumor had successfully been achieved by treatment with imatinib mesylate for six months. Histological proof of GIST by immunohistochemical expression of c-KIT and/or PDGF alpha Receptor is crucial to allow embarking on this treatment strategy.

Conclusion

A multimodal approach for an advanced GIST of the esophagogastric junction with preoperative administration of imatinib mesylate could avoid extended resection. The Merendino procedure might be considered as the reconstruction method of choice after resection of GIST at this location.