Neoadjuvant chemotherapy followed by laparoscopic and endoscopic cooperative surgery for locally advanced duodenal gastrointestinal stromal tumor: A case report

Duodenal gastrointestinal stromal tumors (D-GISTs) near critical structures pose surgical challenges, often necessitating morbid pancreaticoduodenectomy (PD). Neoadjuvant imatinib therapy was administered to a 67-year-old patient with a 55-mm D-GIST, shrinking it significantly to 27 mm. This downsizing allowed for safe, minimally invasive resection via duodenal laparoscopic and endoscopic cooperative surgery (D-LECS). This case highlights neoadjuvant chemotherapy and D-LECS as a less invasive alternative to PD for challenging D-GISTs.