Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases

Abstract

Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5-10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus.

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

“…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).…”

“…On the other side, other authors, among whom we are placed, recommend their excision not only in symptomatic lesions, but also in those asymptomatic sized between 1 and 5 cm, not only due to the rare possibility of malignant degeneration, but also to confirm histopathological diagnosis and differentiate them from GISTs. What also seems clear is the surgical abstention with asymptomatic tumors smaller than 1cm, because of the high difficulty to locate them in the surgical field (19)(20)(21). In such cases annual or biannual follow-up with endoscopic and/or radiologic procedures is recommended (Fig.…”

Minimally invasive surgery for giant esophageal leiomyoma: a case report & review of the literatures

“…The tumor was approximately 15 cm × 2.5 cm × 1.5 cm in size and it was enucleated without mucosal damage. The patient resumed oral intake Esophageal leiomyomas greater than 10 cm in diameter are generally designated as giant leiomyomas (4,5). However, the definition of "giant leiomyoma" seems vague in clinical practice.…”

“…Despite the rapid development of minimally invasive surgery, the indication for thoracoscopic approach is still controversial. Giant tumors are found difficult for surgeons to develop the plane between the tumor and underlying submucosa and small tumors are not good candidates for thoracoscopic enucleation as well, because tumors of small size are difficult to be localized under thoracoscopy (4).…”

Esophageal Leiomyoma with Esophagogastric Junction Outflow Obstruction at High Resolution Manometry

“…The conventional enucleation via thoracotomy, for patients with leiomyomas located in the upper two-thirds of thoracic esophagus, has long been the standard procedure, but the traditional open thoracotomy for enucleation of this tumor has been gradually replaced by minimally invasive thoracoscopic approaches since 1992 [6][7][8][9]. We present the first case of an esophageal leyomioma in patient with a manometric pattern of esophagogastric junction outflow obstruction on highresolution manometry who underwent surgical enucleation successfully by thoracoscopic surgery.…”