Thoracoscopic treatment of benign esophageal tumors.

Abstract

IntroductionGastrointestinal stromal tumors are among the most frequent mesenchymal tumors of the gastrointestinal tract; the incidence of these tumors in the esophagus is less than 5%. Prognosis depends on localization, size, mitotic activity and possible invasion of surrounding structures. Minimally invasive surgery may be maximally utilized for removal of these tumors from the esophageal wall. This operation is usually performed thoracoscopically or laparoscopically and using the “rendez-vous” method – with endoscopic navigation.AimTo evaluate a set of patients with benign tumor of the esophagus who were operated on at the First Department of Surgery from 2006 to 2011.Material and methodsIn the years 2006-2011 a total of 11 patients with benign tumors of the esophagus underwent operation.ResultsOf the 11 patients with esophageal tumor, 5 were diagnosed with gastrointestinal stromal tumor, 5 with leiomyoma and in one patient the lesion was described as heterotopy of the pancreas. We used the minimally invasive rendez-vous method with endoscopic navigation in 9 cases. All patients healed primarily and were released from hospital on the 4th-7th day. These patients are being followed up as outpatients and recurrence of the tumor has not been observed in any of them.ConclusionsMinimally invasive treatment of benign tumors of the esophageal wall is considered to the method of choice. Due to possible complications and the need for subsequent therapy in some patients, these procedures should be centralized to departments with experience in esophageal, thoracic and minimally invasive surgery.

Intramural esophageal tumors

“…Malignant lesions are treated with esophageal resection. Benign lesions can be removed by performing enucleation in VATS or thoracotomy [1, 3, 4, 10, 13]. Inability to enucleate or major damage to the esophageal mucosa is an indication for resection of the esophagus.…”

“…Inability to enucleate or major damage to the esophageal mucosa is an indication for resection of the esophagus. Some authors believe that the biopsy of the tumor performed during EUS may hinder its later separation from the esophageal mucosa [1, 3, 13]. While some recommend observation of benign tumors up to 5 cm in diameter [1, 3], the majority of authors recommend surgical removal of all lesions (including cysts) due to the possibility of their malignant transformation [1, 4, 13].…”

Videothoracoscopy in the treatment of mediastinal cysts.

“…Only severe adhesions are a contraindication to perform VATS. Other reasons for conversion described in the literature, apart from those listed, are bleeding, large size of the cyst, and poor exposure of the lesion [ 8 – 12 ]. In cases of more serious complications it is usually safer and necessary to convert to an open procedure.…”

“…In cases of more serious complications it is usually safer and necessary to convert to an open procedure. Due to possible complications some centres recommend referring patients to departments with experience of thoracic and minimally invasive surgery [ 12 ]. In the case of large cysts it was necessary to puncture and aspirate them.…”

Video-assisted thoracic surgery complications.

“…Pneumonia and atelectasis are the most important of them. A less frequent but significant complication is paralysis of the recurrent laryngeal nerve, which is observed in 3–9% of patients [ 40 – 42 ]. Another complication – leak in the anastomosis (6–9%) – is associated with the technique of making the anastomosis and does not fall within the subject scope of this article [ 41 ].…”