Robotic Approach to Multivisceral Resection for Gastrointestinal Stromal Tumor With En Bloc Resection of the Stomach, Distal Pancreas, and Spleen: A Case Report

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract. While surgical resection is standard for GISTs greater than 2 cm in diameter or those with high-risk features, extraluminal growth and invasion of adjacent organs can present an intraoperative challenge. We report the case of a 75-year-old woman with a large GIST and an unexpected intraoperative finding of direct invasion into the pancreas and spleen, requiring partial gastrectomy with en bloc distal pancreatectomy and splenectomy. A tailored operative approach with a skilled bedside assistant allowed for a successful, complete resection of the GIST and an uncomplicated postoperative recovery. Adjuvant imatinib was started per discussion with the interdisciplinary tumor board. This case highlights the importance of intraoperative flexibility and team-based conduct in managing large GISTs.