Thoracoscopic enucleation of esophageal gastrointestinal stromal tumor using prone positioning in a patient with severe chronic obstructive lung disease

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 21; no. 7; p. 635
• Main Authors: Yamada, Hiroyuki, Shinohara, Tsuyoshi, Yokoyama, Kenji, Takasu, Kaori, Fujimori, Yoshiro, Yamagishi, Kiyohumi
• Format: Journal Article
• Language: English
• Published: United States 01.09.2011
• Subjects: Aged; Esophageal Neoplasms - complications; Esophageal Neoplasms - surgery; Female; Gastrointestinal Stromal Tumors - complications; Gastrointestinal Stromal Tumors - surgery; Humans; Patient Positioning - methods; Prone Position; Pulmonary Disease, Chronic Obstructive - complications; Severity of Illness Index; Thoracoscopy
• ISSN: 1557-9034
• DOI: 10.1089/lap.2011.0264

Abstract Chronic obstructive lung disease (COPD) is a high-risk factor for pulmonary complications in esophageal surgery. We reported a case of esophageal gastrointestinal stromal tumor (GIST) in a patient with severe COPD. Upper gastrointestinal endoscopy and computed tomography revealed a 3×2-cm submucosal tumor at the lower esophagus, and positron emission tomography showed a hypermetabolic mass (SUV(max)=5.6). Forced expiratory volume in 1 second (FEV(1)) was 33.0% of predicted and FEV(1)/forced vital capacity ratio was 40.7%. Taking the patient's lung function into account, we performed a thoracoscopic enucleation for the esophageal GIST while the patient was in a prone position. The postoperative course was uneventful and no significant change was observed in the patient's respiratory condition. Performing thoracoscopic surgery on COPD patients in a prone position is a good therapeutic alternative for reducing the occurrence of pulmonary complications.