Combined thoracoscopic and endoscopic surgery for a large esophageal schwannoma

Abstract

A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.

Total removal of a large esophageal schwannoma by submucosal tunneling endoscopic resection: A case report and review of literature

“…In our reported case, complete resection of esophageal schwannoma was performed using STER alone, and the size of this tumor exceeded the maximum size of esophageal schwannomas in all previously reported cases. Only one reported mass with a maximum diameter of 60 mm[ 12 ] was larger than our case; however, that case was managed by using thoracoscopy combined with endoscopic surgery rather than endoscopic surgery alone. In addition, there were other management methods, including robot-assisted resection of tumors with maximum diameters of 69 mm[ 13 ] and 65 mm[ 14 ] in two cases, and no further treatment measures were taken in the other two cases[ 9 , 15 ] after FNA puncture to obtain pathology.…”

“…However, in all these reports, including cases of esophageal schwannomas treated endoscopically over the past 12 years[ 11 , 12 , 17 , 36 ], the size discussed was the maximum diameter of the tumor, while the supero-inferior diameter, antero-posterior diameter, and left-right diameter of the tumor were not analyzed separately. Due to the narrow structure of the esophagus, many schwannomas are limited by the wall of the esophagus and typically have a narrow shape, which often leads to smaller antero-posterior diameter and left-right diameters of the masses although the long diameter is very large, and gives more operating space for endoscopic surgery.…”

Video-assisted thoracoscopic resection of a giant esophageal schwannoma: A case report

“…Amongst these reported cases, a mini-axillary thoracotomy has been often used for tumors larger than 50 mm [6] , [7] . The largest tumor resected without a thoracotomy is by Onodera et al who used a combined endoscopic and thoracoscopic approach for a 60 mm tumor [8] . Here, we discuss a novel VATS resection of an 80 mm esophageal schwannoma without a thoracotomy in a 60-year-old woman with a prior bariatric gastric bypass.…”

Combined thoracoscopic and submucosal endoscopic surgery for esophageal submucosal tumors: Is it really useful?

“…The ischemic and necrotic tissue within the liver metastases presents the perfect microenvironment for its growth [3]. Almost 90% of C. septicum cases have malignancy, almost 90% of which originate in the gastrointestinal tract [4]. Although C. septicum only represents 11% of all clostridial infections, it has the greatest association to malignancy (50% of cases) whereas other clostridial infections are only associated with cancer 11% of the time [5].…”