Minimally invasive resection of multifocal duodeno-jejunal gastrointestinal stromal tumors in neurofibromatosis type 1
4 affiliations
- 1Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano
- 2Humanitas University, Pieve Emanuele
- 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- 4Pathology Department, IRCCS Humanitas Research Hospital, Rozzano
Abstract
Gastrointestinal Stromal Tumors (GISTs) in Neurofibromatosis Type 1 (NF-1) are typically multifocal, small-bowel-based, and wild-type for KIT and PDGFRA, so surgery remains the cornerstone of treatment. Multifocal duodeno-jejunal involvement poses technical and strategic challenges, and minimally invasive management in this setting is poorly standardized. We describe a hybrid laparoscopic–mini-open, bowel-preserving approach. Laparoscopic access via the Hasson technique with three additional trocars allows systematic small-bowel exploration. Division of the ligament of Treitz and a complete Kocher maneuver fully mobilize the duodeno-pancreatic block. Targeted lesions are exteriorized through a short Alexis-protected minilaparotomy and removed by manual full-thickness wedge resection with double-layer closure. A selective strategy is applied: only enlarging or anatomically critical lesions are resected, while subcentimeter micro-GISTs are left in situ . In a 62-year-old man with NF1 and three growing GISTs (duodenal and jejunal), all targeted lesions were resected with negative (R0) margins. Histology confirmed low-risk and no risk tumors. Recovery was uneventful aside from transient delayed gastric emptying, and the patient was recurrence-free at 12 months. This standardized, reproducible technique provides a tailored minimally invasive option for multifocal NF1-associated GISTs, preserving bowel length without compromising oncologic adequacy.
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BibTeX
@article{sama2026minimally,
title = {{Minimally invasive resection of multifocal duodeno-jejunal gastrointestinal stromal tumors in neurofibromatosis type 1}},
author = {Laura Samà and Federica Bezzi and Marta Casiraghi and Vittoria D’Amato and Sonia Kumar and Laura Ruspi and Federico Sicoli and Salvatore Lorenzo Renne and Vittorio Lorenzo Quagliuolo and Ferdinando Carlo Maria Cananzi},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1909970},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1909970/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Minimally invasive resection of multifocal duodeno-jejunal gastrointestinal stromal tumors in neurofibromatosis type 1
AU - Laura Samà
AU - Federica Bezzi
AU - Marta Casiraghi
AU - Vittoria D’Amato
AU - Sonia Kumar
AU - Laura Ruspi
AU - Federico Sicoli
AU - Salvatore Lorenzo Renne
AU - Vittorio Lorenzo Quagliuolo
AU - Ferdinando Carlo Maria Cananzi
PY - 2026
DA - 2026/10/30
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1909970
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1909970/full
AB - Gastrointestinal Stromal Tumors (GISTs) in Neurofibromatosis Type 1 (NF-1) are typically multifocal, small-bowel-based, and wild-type for KIT and PDGFRA, so surgery remains the cornerstone of treatment. Multifocal duodeno-jejunal involvement poses technical and strategic challenges, and minimally invasive management in this setting is poorly standardized. We describe a hybrid laparoscopic–mini-open, bowel-preserving approach. Laparoscopic access via the Hasson technique with three additional trocars allows systematic small-bowel exploration. Division of the ligament of Treitz and a complete Kocher maneuver fully mobilize the duodeno-pancreatic block. Targeted lesions are exteriorized through a short Alexis-protected minilaparotomy and removed by manual full-thickness wedge resection with double-layer closure. A selective strategy is applied: only enlarging or anatomically critical lesions are resected, while subcentimeter micro-GISTs are left in situ . In a 62-year-old man with NF1 and three growing GISTs (duodenal and jejunal), all targeted lesions were resected with negative (R0) margins. Histology confirmed low-risk and no risk tumors. Recovery was uneventful aside from transient delayed gastric emptying, and the patient was recurrence-free at 12 months. This standardized, reproducible technique provides a tailored minimally invasive option for multifocal NF1-associated GISTs, preserving bowel length without compromising oncologic adequacy.
SN - 2234-943X
ER -