Organ-Preserving Gastric Wedge Resection for a Giant Posterior Gastric Gastrointestinal Stromal Tumor: A Case Report

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, with the stomach representing the predominant site of origin. Although complete surgical resection remains the standard treatment for localized disease, the management of giant gastric GISTs can be challenging because of their size, anatomical relationships, and the risk of tumor rupture during surgery. We report the successful organ-preserving resection of a giant posterior gastric GIST using a wedge resection technique. A 49-year-old woman presented with a two-year history of abdominal pain, postprandial discomfort, abdominal distension, nausea, and vomiting. Contrast-enhanced computed tomography revealed a large lobulated mass measuring 14.0 × 12.0 × 11.0 cm, closely associated with the stomach. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the muscularis propria, and fine-needle aspiration findings were consistent with GIST. Exploratory laparotomy through a midline incision identified a giant exophytic tumor arising from the posterior gastric wall without evidence of metastatic disease or adjacent organ invasion. Complete resection was achieved by gastric wedge resection using a 75-mm linear stapler, avoiding formal gastrectomy. The operative time was 120 minutes, estimated blood loss was 100 mL, and no intraoperative complications occurred. The patient was discharged on postoperative day 3. Histopathological examination demonstrated an 11.1 × 10.8 × 8.5 cm spindle-cell GIST positive for CD117 and DOG1, with low mitotic activity, negative surgical margins, and pathological stage pT4. According to the modified NIH (Joensuu) risk stratification criteria, the tumor was classified as having a moderate risk of recurrence. Giant posterior gastric GISTs can be safely managed with organ-preserving wedge resection when complete oncologic excision is feasible. Careful surgical planning and meticulous handling to avoid tumor rupture may allow excellent short-term outcomes while preserving gastric anatomy and function.