Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach

Rahden, B. H. A. von; Stein, Hubert J.; Feußner, H.; Siewert, J. R.

doi:10.1007/s00464-003-9130-9

Cited by 126 publications

(101 citation statements)

References 23 publications

(16 reference statements)

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“…In our series 3 preoperative biopsies were performed (23.08%), most of them in the earlier cases, and none achieved histopathological diagnosis of the tumor. Fortunately, and even though complications related to biopsy have been described, such as infection, bleeding, increased intraoperative esophageal perforation rate (3,6,15) and increased technical difficulties in surgical dissection to perform an extramucosal enucleation due to mucosal and submucosal scarring (17), no complications appeared in our series. In our opinion, preoperative biopsy should only be performed in situations such as diagnostic doubt, previous history of malignancy or suspicion of unresectable disease to determine the need of other neoadjuvant therapies.…”

Section: Discussionmentioning

confidence: 68%

“…However, since the first thoracoscopic enucleations performed by Everitt (24) and Bardini (25) in 1992, minimally invasive procedures have rapidly increased, and many studies have demonstrated that with MIS shorter postoperative stay, better pulmonary re-expansion with less pulmonary complications, reduced wound related pain and reduced postoperative discomfort are achieved (6,(8)(9)(10). In our opinion, if the tumor is located in the upper/middle third of the esophagus, a thoracic approach is recommended, preferably a thoracoscopic approach, and if the tumor locates in the distal third of the esophagus, a conventional transhiatal laparoscopic approach is preferred.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are authors that suggest that it could be left open without subsequent complication, the majority, among whom we are placed, recommend to close the muscular layer following enucleation with non-absorbable interrupted suture, in order to repair the esophageal wall and preserve the propulsive activity of the esophageal body (3,6,10,15,(19)(20)(21)26), and to avoid mucosal bulging and formation of pseudodiverticula which can cause postoperative dysphagia, which has been described by many authors. Large tumors' enucleations have been associated with muscle atrophy and large extramucosal defects, not allowing a tension-free suture, which can require tissue flaps with pleural films, diaphragm, omentum or pericardium (20).…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of these tumors is, in most cases, surgical enucleation, which would be indicated in big or symptomatic tumors, or tumors that show growth after initial observation (6). Traditionally, surgical excision has been performed through an open approach (thoracotomy or laparotomy) (7); however, the boom of endoscopic and minimally invasive procedures has completely changed the therapeutic management of these tumors (6,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, surgical excision has been performed through an open approach (thoracotomy or laparotomy) (7); however, the boom of endoscopic and minimally invasive procedures has completely changed the therapeutic management of these tumors (6,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

et al. 2015

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Introduction: Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors. Material and methods:We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain) between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay.Results: Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years). Surgical enucleation was achieved in all patients. In 8 cases (61.54%) a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies), and in 5 cases (38.56%) an abdominal approach was performed (3 laparotomies and 2 laparoscopies); enucleation was carried out through a minimally invasive approach in 6 patients (46.15%). There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes) and median postoperative stay was 6.5 days (range 2-27 days). There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months) no recurrences were reported.Conclusion: Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group. Paradoxically, incision pain after surgery (thoracic neuralgia) was found to be higher in the minimally invasive approach group. Nevertheless, none of the results obtained in the study reached statistical significance, probably due to the small simple size.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

et al. 2015

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Analysis of 151 consecutive gastric submucosal tumors according to tumor location

Lee

Hur

Jung

et al. 2010

Journal of Surgical Oncology

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Robotic‐assisted enucleation of a large lower esophageal leiomyoma and review of literature

Khalaileh

Savetsky

Adileh

et al. 2013

Robotics Computer Surgery

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Leiomyoma is the most common benign esophageal neoplasm. Different invasive surgical approaches have been described for management of such lesions. The literature is reviewed and a robotic assisted left thoracoscopic enucleation with the patient in the right side position is described. A 40-year-old male patient, otherwise healthy, found to have a lower midiastinal mass on screening X-ray, is described. Physical examination and blood tests were within normal limits. Diagnostic work-up included: computerized tomography (CT) scanning of the chest and midiastinum that revealed a 40 × 30 mm mass of the distal esophagus, an upper gastrointestinal endoscopy showed a lower protruding esophageal submucosal mass with intact mucosa, a filling defect was apparent on esophagography. Endoscopic ultrasonography (EUS) showed the same findings, biopsies were taken and leimyoma was diagnosed. Under general anesthesia with a double-lumen endotracheal tube, the patient was positioned on his right side. A 30 robotic scope was introduced in the left 7th intercostal space on the posterior axillary line. Two 8-mm robotic trocars were inserted in the left 5th and 9th intercostals spaces on the same line. Operative field was clearly exposed and an additional 5-mm ethicon trocar was inserted. The inferior pulmonary ligament was released, the parietal pleural space opened, proximal and distal control was achieved using Penrose. The muscular layer of the lower esophagus was opened by coagulation hook, the lesion was enucleated without mucosal penetration. Intraoperative endoscopy permitted localization of the lesion and ensured mucosal integrity. The muscular layer was not closed and the chest drain was left. Total operative time was 200 min and blood loss was less than 20 mL. A Gastrograffin swallow on the first post-operative day showed good esophageal clearance and absence of leak, the patient was allowed a liquid diet. He was discharged on the third post-operative day in a good general condition, benign pathology was confirmed.

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Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach

Abstract: Minimally invasive approaches are suitable for the surgical enucleation of submucosal esophageal tumors. Thoracoscopic and laparoscopic techniques are recommended as standard procedures in experienced centers.

Cited by 126 publications

References 23 publications

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

Analysis of 151 consecutive gastric submucosal tumors according to tumor location

Robotic‐assisted enucleation of a large lower esophageal leiomyoma and review of literature

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