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Thoracoscopic enucleation of esophageal gastrointestinal stromal tumor using prone positioning in a patient with severe chronic obstructive lung disease.

Abstract Chronic obstructive lung disease (COPD) is a high-risk factor for pulmonary complications in esophageal surgery. We reported a case of esophageal gastrointestinal stromal tumor (GIST) in a patient with severe COPD. Upper gastrointestinal endoscopy and computed tomography revealed a 3×2-cm submucosal tumor at the lower esophagus, and positron emission tomography showed a hypermetabolic mass (SUV(max)=5.6). Forced expiratory volume in 1 second (FEV(1)) was 33.0% of predicted and FEV(1)/forced vital capacity ratio was 40.7%. Taking the patient's lung function into account, we performed a thoracoscopic enucleation for the esophageal GIST while the patient was in a prone position. The postoperative course was uneventful and no significant change was observed in the patient's respiratory condition. Performing thoracoscopic surgery on COPD patients in a prone position is a good therapeutic alternative for reducing the occurrence of pulmonary complications.