Surgical Treatment for Esophageal Leiomyoma: 13 Years of Experience in a High-Volume Tertiary Hospital

Abstract

BackgroundEsophageal leiomyoma is the most common benign tumor in the esophagus. Thoracotomy and thoracoscopy are both elective for esophageal leiomyoma enucleation. This study aimed at presenting surgical experience in our center and exploring more suitable surgical methods for different situations.MethodsWe conducted this retrospective study by collecting data from patients who underwent esophageal leiomyoma enucleation through thoracotomy or thoracoscopy from January 2009 to November 2021 at West China Hospital Sichuan University.ResultsA total of 34 patients were enrolled for analysis. All patients were diagnosed with a single esophageal leiomyoma. There were 25 men and 9 women. The mean age was 44.41 years (range, 18–72 years), the mean longest diameter was 4.99 cm (range, 1.4–10 cm), and the esophagus was thoroughly circled with leiomyoma in 10 patients, 10 patients underwent thoracotomy to enucleate leiomyoma, while others underwent thoracoscopic enucleation. No perioperative deaths occurred. Between the thoracotomy group and thoracoscopy group, baseline characteristics were comparable except for gastric tube status (p = 0.034). Patients were inclined to undergo the left lateral surgery approach (p = 0.001) and suffered esophagus completely encircled by leiomyoma (p = 0.002). Multivariable logistic regression analysis demonstrated that the left lateral surgery approach (p = 0.014) and esophagus completely encircled by leiomyoma (p = 0.042) were risk factors for thoracotomy of leiomyoma enucleation, while a larger tumor size demonstrated no risk. The median follow-up time was 63.5 months, and no deaths or recurrence occurred during the follow-up period.ConclusionThoracotomy enucleation of the leiomyoma was recommended when the esophagus was thoroughly encircled by the leiomyoma and the left lateral surgery approach was needed. However, tumor size demonstrated less value for selecting a surgical approach.

Video-assisted thoracoscopic surgery (VATS) enucleation of large gastroesophageal junction leiomyoma: A case report

“…This patient's leiomyoma was larger than most, as esophageal leiomyomas larger than 5 cm are relatively rare [7] . As a result, this patient was recommended for surgery under the current guidelines that recommend surgical management for esophageal leiomyomas that are larger than 5 cm or that are symptomatic [2] , [7] . This patient's esophageal leiomyoma was located at the GEJ, which can be a difficult area to enucleate large leiomyomas due to potential stricture at the GEJ [2] .…”

“…As a result, this patient was recommended for surgery under the current guidelines that recommend surgical management for esophageal leiomyomas that are larger than 5 cm or that are symptomatic [2] , [7] . This patient's esophageal leiomyoma was located at the GEJ, which can be a difficult area to enucleate large leiomyomas due to potential stricture at the GEJ [2] . The patient was consented for possible minimally invasive esophagectomy (MIE) if the GEJ were to become compromised.…”

“…Leiomyomas are benign tumors of smooth muscle origin, most commonly of the uterus, small bowel, or esophagus [1] , [2] . While esophageal leiomyomas are rare, only accounting for 1 % of total esophageal neoplasms, they are the most common mesenchymal esophageal tumors [3] , [4] .…”

“…Surgical treatment is typically only recommended for leiomyomas that are symptomatic or larger than 5 cm [7] . The historical surgical approach for esophageal leiomyoma is an open thoracotomy followed by extra mucosal blunt enucleation [2] . This approach has been replaced over time by minimally invasive thoracoscopic approaches, including video-assisted thoracoscopic surgery (VATS) [8] , [9] .…”

“…However, the size and location of the tumor can modify the surgical difficulty and the risk of the procedure. For surgeries that are considered to be higher risk, an open thoracotomy may still be the method of choice [2] . Here we present a case of a 46-year-old female patient with a large gastroesophageal junction (GEJ) leiomyoma that was treated with VATS.…”