(P 203) MINIMALLY INVASIVE RESECTION OF MULTIFOCAL DUODENO-JEJUNAL GISTS IN NEUROFIBROMATOSIS TYPE 1

Objective: To assess the feasibility, surgical technique, and early clinical outcomes of a minimally invasive, organ-sparing approach in resecting multiple synchronous duodeno‑jejunal gastrointestinal stromal tumors (GISTs) in a patient with neurofibromatosis type 1 (NF1).

Methods: A 62-year-old male with NF1 was diagnosed with three GISTs (duodenal: 2.7 cm; jejunal: 1.0 and 1.2 cm) via EUS-guided biopsy and contrast-enhanced CT. A multidisciplinary tumor board recommended surgery due to documented lesion growth.

Results: A minimally invasive approach was adopted, beginning with the Hasson open technique for laparoscopic access. Three additional trocars (two 5 mm, one 10 mm) were placed for full abdominal exploration, which revealed the known lesions and multiple millimetric nodules along the jejunum. Complete duodeno-pancreatic mobilization was achieved via Kocher maneuver and division of the ligament of Treitz. Wedge resections were performed through a minilaparotomy with Alexis retractor assistance. All lesions were excised manually and closed using a double-layer Maxon 3/0 suture. Pathological examination confirmed R0 margins. The duodenal GIST had a mitotic index of 1/5 mm² (low-risk), and both jejunal GISTs had < 1/5 mm² mitoses (very low-risk). Postoperative recovery was uneventful, except for transient delayed gastric emptying, which resolved spontaneously.

Conclusion: Minimally invasive, organ-sparing resection is a feasible and safe strategy for managing multifocal duodeno‑jejunal GISTs in NF1 patients. This approach enables complete tumor removal while preserving gastrointestinal function and offers a reproducible solution for such complex presentations.