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Agarwal L, Pal S, Dash NR, Madhusudhan KS, Das P, Gunjan D, Sahni P, Chattopadhyay TK. Surgery for mesenchymal neoplasms of the esophagus: experience over 2 decades from a tertiary healthcare center in India. Updates Surg 2022; 74:1889-1899. [PMID: 36149582 DOI: 10.1007/s13304-022-01373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Mesenchymal tumors are the most common benign neoplasms of the esophagus. Owing to the rarity of these neoplasms, there is a dearth of literature regarding their diagnosis and management. Our 2-decade-long experience in managing these neoplasms surgically is presented. Relevant clinical data of all patients with esophageal mesenchymal neoplasms (EMNs) managed between January 2000 and May 2020 were retrospectively collected from a prospectively maintained esophageal diseases database in the Department of GI Surgery, AIIMS, New Delhi (India). Special emphasis was given to data pertaining to diagnostic evaluation of patients, type of surgery done (enucleation vs. resection), postoperative outcomes, histopathology and long-term follow-up. Nineteen patients (12 females; age 15-66 years) underwent surgery for EMN (mean tumor size 7.6 cm; enucleation 10; resection 9). On histopathological examination, 17 cases were noted to be benign esophageal leiomyomas and 2 were identified as gastrointestinal stromal tumors. There was no perioperative mortality. All cases were followed up for a median duration of 6 years (range 1-19 years) with no evidence of recurrence in any case. Though EMNs are uncommon, they are mostly benign, and the long-term outcomes after surgical excision are gratifying.
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Affiliation(s)
- Lokesh Agarwal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | | | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Tushar Kanti Chattopadhyay
- Department of Hepatopancreatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
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Froiio C, Berlth F, Capovilla G, Tagkalos E, Hadzijusufovic E, Mann C, Lang H, Grimminger PP. Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series. Updates Surg 2022; 74:1043-1054. [PMID: 35147859 PMCID: PMC9213313 DOI: 10.1007/s13304-022-01247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
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.
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Affiliation(s)
- Caterina Froiio
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany.,Department of General Surgery , IRCCS Policlinico San Donato, University of Milan , Milano, Italy
| | - Felix Berlth
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | | | | | | | - Carolina Mann
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Hauke Lang
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
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Yendamuri K, Brady M, Hochwald SN, Kukar M, Peng JS. Robotic Enucleation of a Large Gastroesophageal Junction Leiomyoma. Ann Surg Oncol 2021; 28:8973-8974. [PMID: 34269938 DOI: 10.1245/s10434-021-10409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
In this multimedia article, we demonstrate transabdominal robotic enucleation of a large, multilobulated leiomyoma at the gastroesophageal junction (GEJ). The robotic platform provides stereoscopic visualization and wristed motion, which improved ease of an organ-sparing resection in a challenging anatomic location. Alternative minimally invasive approaches to tumors in this location have been reported including endoscopic, endoscopic with laparoscopic assistance, laparoscopic, and thoracoscopic approaches, with choice of approach dependent upon the location and configuration of the tumor Milito et al. in J Gastrointest Surg 24:499-504, 2020;Li et al. in Dis Esophagus. 22:185-189, 2009;Armstrong et al. in Am Surg. 79:968-972, 2013;Kent et al. in J Thorac Cardiovasc Surg. 134:176-181, 2007.
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Affiliation(s)
- Keerti Yendamuri
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maureen Brady
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Steven N Hochwald
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Moshim Kukar
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - June S Peng
- Division of Surgical Oncology, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA.
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Kemuriyama K, Motoyama S, Sato Y, Wakita A, Nagaki Y, Fujita H, Sasamori R, Imai K, Aokawa M, Minamiya Y. Robot-assisted thoracoscopic enucleation for a large esophageal leiomyoma: a case report. Surg Case Rep 2021; 7:129. [PMID: 34037886 PMCID: PMC8155148 DOI: 10.1186/s40792-021-01212-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is being used to treat esophageal submucosal tumors (SMTs) all over the world. However, this technique is difficult when the tumor is large and located on the left side wall of the esophagus, within the upper mediastinum. This is because, with VATS, the surgical forceps have a limited range of motion. Robot-assisted thoracoscopic surgery (RATS) using the da Vinci surgical system may be extremely useful for enucleation of esophageal SMTs within the narrow upper mediastinum. Case presentation A female in her thirties experiencing epigastric pain visited our hospital and was diagnosed with a large esophageal leiomyoma within the upper mediastinum. From its size (10 cm), it was judged to have malignant potential. We performed SMT enucleation using RATS with a da Vinci surgical system Xi. This was our second case using this system. The patient was placed in the left lateral position. Four da Vinci trocars (8 mm) were inserted into the 10th, 7th, 5th and 3rd intercostal spaces (ICS), and an assist port was added in the 5th ICS. We opened the superior mediastinal pleura cranially and caudally from the arch of the azygos vein and expanded the superior mediastinum after dividing the azygos vein. We made an incision in the muscular layer of the esophagus and, using a monopolar hook and monopolar scissors, enucleated the esophageal tumor in a protective manner so as not to damage its capsule or mucosa while applying appropriate robot-specific counter traction. We then sewed up the muscularis using 4–0 Vicryl, inserting the endoscope into the thoracic esophagus to substitute for a bougie. In addition, the pleura was sutured using barbed suture. The surgical procedure was straightforward and smooth. The patient was discharged on postoperative day 4 with no surgical complications. The tumor was definitively diagnosed pathologically from paraffin sections as a benign esophageal leiomyoma. Conclusions RATS enables more delicate and precise esophageal SMT enucleation without surgical complications, though various challenges remain to be overcome. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-021-01212-9.
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Affiliation(s)
- Kohei Kemuriyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan. .,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan. .,Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yusuke Sato
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yushi Nagaki
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromu Fujita
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryohei Sasamori
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita, 010-8543, Japan.,Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaki Aokawa
- Gastroenterology, Noshiro Kousei Medical Center, Noshiro, Japan
| | - Yoshihiro Minamiya
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Figueiredo LM, Rafael MA, Branco JC, Rodrigues CG, Alves AT, Horta D, Martins A. Multidisciplinary Approach to Diagnose and Treat Diffuse Esophageal Leiomyomatosis: A Case Report. Clin Endosc 2020; 53:754-756. [PMID: 33232595 PMCID: PMC7719413 DOI: 10.5946/ce.2020.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Maria Ana Rafael
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Joana C Branco
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Catarina G Rodrigues
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - António T Alves
- Department of Pathology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - David Horta
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Alexandra Martins
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Clinical outcomes in the surgical treatment of esophageal leiomyoma: A retrospective evaluation of 13 cases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:505-513. [PMID: 32953214 DOI: 10.5606/tgkdc.dergisi.2020.18889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023]
Abstract
Background In this study, we aimed to evaluate the surgical outcomes after enucleation of esophageal leiomyomas and present the feasibility of enucleation using video-assisted thoracoscopic surgery. Methods The medical records of 13 patients (8 males, 5 females; mean age 45.9 years; range, 30 to 69 years) who underwent open or thoracoscopic surgery for an esophageal leiomyoma between April 2007 and June 2019 were retrospectively reviewed. The patients were evaluated with regard to age, sex, presenting symptoms, duration of symptoms, size and localization of tumors, diagnostic methods, surgical methods, conversion to open surgery, morbidity and mortality, discharge time, and follow-up period. Results Of the patients, four were operated via thoracotomy and nine via video-assisted thoracoscopic surgery. Enucleation was successfully completed with thoracoscopy in five patients. Four patients required conversion to thoracotomy. In the early postoperative period, two of these four patients developed complications and underwent re-thoracotomy. A solitary leiomyoma was detected in all, but one patient (multiple). The mean size of the tumors was 68.4 mm. Complications were seen in only one patient during follow-up and no recurrence was observed in any patient. Conclusion Our study results indicate that thoracoscopic enucleation of esophageal leiomyoma is a safe, feasible, and effective technique in selected patients and conversion to open surgery can be easily done for any reason during the procedure.
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Bernardi D, Ferrari D, Siboni S, Porta M, Bruni B, Bonavina L. Minimally invasive approach to esophageal lipoma. J Surg Case Rep 2020; 2020:rjaa123. [PMID: 32760482 PMCID: PMC7394138 DOI: 10.1093/jscr/rjaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/10/2020] [Indexed: 12/25/2022] Open
Abstract
Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.
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Affiliation(s)
- Daniele Bernardi
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Davide Ferrari
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Stefano Siboni
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Matteo Porta
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Barbara Bruni
- Pathology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Bonavina
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
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