Complete laparoscopic-transhiatal removal of duplex benign oesophageal tumour: case report and review of literature

Abstract

Background Leiomyoma is the most common benign oesophageal tumour. Half of all leiomyoma patients have oesophagus-associated complaints, such as dysphagia and epigastric pain, and the other 50% are asymptomatic with a diagnosis made on incidental discovery. Endoscopic ultrasonography is essential for an accurate preoperative workup and can enable guided-tissue acquisition for immunohistochemistry in certain cases. Smaller tumours are amenable to traditional and novel endoscopic removal in specialized centres, but some complex cases require surgical enucleation with a minimally invasive approach. Case presentation An asymptomatic 60-year-old woman was accidentally diagnosed with a bifocal oesophageal mass, which was discovered by chest computed tomography. We report a rare case of a duplicated lower-third oesophageal leiomyoma, which was completely removed via the laparoscopic transhiatal approach. The patient has recovered successfully from the surgery. She has been followed up for six months with a normal oesophagram, adequate oesophageal function and no complaints observed. Pathological examination confirmed the diagnosis of leiomyoma in both lesions. Conclusions To the best of our knowledge, this is the first reported case of duplex oesophageal leiomyomas removed laparoscopically. Using the minimally invasive abdominal technique, the lower oesophagus can be mobilised to the mediastinum without pleura injury and offers a good alternative to the thoracoscopic approach in patients with possible intrathoracic difficulties. At experienced centres, laparoscopic transhiatal enucleation of lower oesophageal leiomyomas and other benign tumours with a combination of intraoperative oesophagoscopy is a safe, fast and effective operation.

Transhiatal laparoscopic enucleation of lower thoracic esophageal leiomyoma

“…При лейомиомах пищевода хирургическое лечение в объеме энуклеации опухоли показано в случае симптомного течения заболевания, быстром темпе роста или при размерах опухоли более 3 см [6,10]. Если не планируется неоадъювантная терапия, то морфологическая верификация не обязательна, поскольку это не меняет тактику лечения [11]. Обязательными требованиями к органосохраняющему хирургическому лечению являются радикальное удаление опухоли без повреждения ее капсулы, блуждающих нервов и попытка сохранения слизистой оболочки пищевода.…”

“…Лапароскопический доступ с трансхиатальной мобилизацией пищевода обеспечивает хорошие условия для выполнения энуклеации опухолей до уровня наддиафрагмального сегмента [11]. В 2019 г. E. Asti et al опубликовали результаты 35 выполненных лапароскопических энуклеаций опухоли пищевода.…”