Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series

Abstract

Esophageal submucosal tumors (SMTs) are rare heterogenous clinical entities. The surgical resection can be performed in different surgical approaches. However, the robotic surgical strategy is poorly documented in the treatment of SMTs. We present our series of operated esophageal SMTs approached via robotic-assisted surgery. Six patients with symptomatic esophageal submucosal tumors underwent robotic surgery within a 3-year period. The performed procedures were robotic-assisted enucleation, robotic esophagectomy (RAMIE) and reverse hybrid robotic esophagectomy. Patients’ clinical data, intra/postoperative outcomes, and histopathological features were retrieved from the institution’s prospective database. Five of six patients were scheduled for upfront surgery: four underwent robotic enucleation (three leiomyoma and one suspected GIST) and one underwent reverse hybrid robotic esophagectomy (suspected GIST). One patient, diagnosed with GIST, was treated with neoadjuvant Imatinib therapy, before undergoing a RAMIE. No major intra-operative complications were recorded. Median length of stay was 7 days (6–50), with a longer post-operative course in patients who underwent esophagectomy. Clavien–Dindo > 3a complications occurred in two patients, aspiration pneumonia and delayed gastric emptying. The final histopathological and immuno-histochemical diagnosis were leiomyoma, well-differentiated GIST, low-grade fibromyxoid sarcoma and Schwannoma. Robotic-assisted surgery seems to be a promising option for surgical treatment strategies of benign or borderline esophageal submucosal tumors.

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

“…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.…”

Robotic-assisted surgical enucleation of esophageal gastrointestinal stromal tumor

“…A 2022 single-center case series reports the use of robotic-assisted surgery in 6 patients with esophageal submucosal tumors. E2 Four patients underwent robotic enucleation (3 leiomyomas and 1 suspected GIST), whereas 1 patient with suspected GIST underwent reverse hybrid robotic esophagectomy. E2 One patient with confirmed GIST was treated with neoadjuvant imatinib therapy followed by robotic esophagectomy.…”

“… E2 One patient with confirmed GIST was treated with neoadjuvant imatinib therapy followed by robotic esophagectomy. E2 …”