Surgical treatment of esophageal leiomyoma: an analysis of our experience

Abstract

Introduction: leiomyoma is the most common benign esophageal neoplasm. Surgical treatment (enucleation) has traditionally been the therapy of choice. The advent of minimally invasive techniques has produced an increase in endoscopic approaches to the detriment of open surgery. Objective: the aim of this study was to compare the results obtained with open surgery and with laparoscopic surgery in this kind of pathology. Material and methods: we performed a retrospective study of all leiomyomas operated for in our center between 1986 and 2004, and obtained 9 cases of esophageal leiomyoma. Four were women and five men, between the ages of 40 and 70, with a mean age of 53.5 years. The most frequent symptoms were heartburn (5 cases), dysphagia (3 cases), and retrosternal pain (3 cases). Surgery was in all the cases an enucleation. An open approach was performed in 5 cases (3 thoracotomies and 2 laparotomies), and an endoscopic approach in 4 (2 thoracoscopies and 2 laparoscopies). Results: the mean postoperative hospital stay was 5.12 days (range 2-8 days). This was shorter for endoscopic approaches versus open surgery (3.25 vs. 7 days). There was no case of esophageal mucosal perforation or reconversion. No death, intraoperative complication, or tumor relapse was described. Only 2 patients had complications: post-surgical thoracic pain, and intestinal obstruction by adhesions 8 years after surgery. Conclusion: enucleation is an easier procedure and constitutes the therapy of choice for esophageal leiomyoma. This approach has to be laparoscopic. We think that muscle borders should be closed after enucleation, and that biopsy is not indicated preoperatively.

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

“…Surgical procedure, both for OS and MIS was already described by the authors in previous articles (11,12).…”

Approach to esophageal leiomyoma: a report of eight cases

“…An operation is indicated in cases with a continued increase in tumor size and mucosal ulceration, which can also be used to facilitate histopathological diagnosis and other surgical procedures. [11] We think removal should be done in patients suspected of having leiomyomas, even if they are asymptomatic. If there is no treatment or if it is delayed, serious symptoms can present, and malignant transformation might even occur in the future, though this is a rare event.…”

“…Left thoracotomies, thoracoabdominal incisions, or laparoscopies are preferred in lesions situated in the distal section. [11,13,15] In this study, we had five cases located in the middle third of the esophagus with right hemithorax, and we performed video-assisted thoracoscopic surgery (VATS) on three of the patients while two underwent thoracotomies. Enucleation was also performed in these cases since the surgeon had experience with this procedure.…”

“…However, it is not recommended for leiomyoma patients because needle aspiration is not suitable for them. [1,2,11] In this study, we utilized esophagoscopies and CT in all of the cases, and an MRI was also performed on two of the patients.…”

Leiomioma esofágico: resección por videotoracoscopia. A propósito de un caso

“…La resección mínimamente invasiva de tumores benignos del esófago es técnicamente segura y se asocia con un menor tiempo de estancia en comparación con los enfoques abiertos 8,9 . De esta forma se obtiene: a) una menor tasa de hospitalización; b) una menor incomodidad para el paciente; c) una rá-pida y completa re-expansión del pulmón 10 . La videotoracoscopia fue el tratamiento a seguir en este caso y aportó al paciente ventajas con respecto al dolor postoperatorio, la rápida recuperación y sin las complicaciones pulmonares asociadas a diferencia que otros tratamientos más invasivos.…”