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A-Lai GH, Hu JR, Yao P, Lin YD. Surgical Treatment for Esophageal Leiomyoma: 13 Years of Experience in a High-Volume Tertiary Hospital. Front Oncol 2022; 12:876277. [PMID: 35530349 PMCID: PMC9071360 DOI: 10.3389/fonc.2022.876277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Gu-Ha A-Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian-Rong Hu
- Operating Room of Anesthesia Surgery Center, West China Hospital/West China School of Nursing, Chengdu, China
| | - Peng Yao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Dan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yi-Dan Lin,
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Giant oesophageal leiomyoma as a diagnostic and therapeutic problem - a case report. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:79-82. [PMID: 26336401 PMCID: PMC4283910 DOI: 10.5114/kitp.2014.41938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/06/2013] [Accepted: 12/20/2013] [Indexed: 11/17/2022]
Abstract
Oesophageal leiomyoma is a rare benign tumour of the oesophagus, which does not cause clinical symptoms in more than half of cases. Below we present the case of a symptomless oesophageal tumour. Due to the unequivocal result of imaging examinations and no histopathological diagnosis the patient was qualified for thoracotomy. During the operation the oesophageal tumour was suspected of passing through the hiatus into the abdominal cavity. The specimen revealed a neoplasm of mesenchymal origin without distinct traits of malignancy. The patient was admitted to the Surgical Department, where she was qualified for surgery, which was carried out by a team of surgeons and thoracic surgeons. The encapsulated tumour and oesophagus were resected. The histopathological and immunohistochemical examinations corres ponded to leiomyoma oesophagi. The lesion was radically resected. The size of the lesion was 22 × 14 × 13 cm. Three months after the surgery no traits of relapse were found.
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Pinheiro FAS, Campos AB, Matos JRF, Araripe DPDA. Videoendoscopic surgery for the treatment of esophagus' leiomyoma. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:234-7. [PMID: 24190384 DOI: 10.1590/s0102-67202013000300015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Leiomyomas are the commonest benign esophageal neoplasms. Surgical treatment is the therapy of choice for such tumors. Open enucleation via thoracotomy has long been the standard procedure. With the emergence of thoracoscopic and laparoscopic approaches, minimally invasive surgery represent interesting alternatives to open surgical procedures. AIM To propose endoscopic technique for the treatment of these myomas avoiding thoracotomy. TECHNIQUE Enucleation of leiomyoma by: A) thoracoscopy, for thoracic esophageal tumors, or B) laparoscopy to the ones located in abdominal esophagus. A) The operations are performed under general anesthesia with selective intubation of the left lung. Patients are placed in the left lateral decubitus position and mild dorsiflexion. Four work trocars are used, two of 11 mm and two of 5 mm. One of the 11 mm is put in the 6(th) intercostal space in the posterior axillary line to use the 30° endoscope; another, at the same hemi-clavicular line, to take the lung away off surgical site. Other two trocars of 5 mm are installed for working tools of the surgeon, one in the 4(th) space in the posterior axillary line, and another in the 7(th), also in the posterior axillary line. Operations are always initiated by opening the mediastinal pleura, dissection of the tumor with opening the muscle of the esophageal wall, simple enucleation of the tumor and closure of esophageal parietal muscular layer. B) The interventions are done with patients undergoing general anesthesia and placed in the French position. The approach is the same performed to correct the hiatal hernia, and enucleation is done without difficulty. CONCLUSION Videosurgery for leiomyomas resection is safe and feasible and provides results similar to open procedure, but with a significant reduction in morbidity.
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Khalaileh A, Savetsky I, Adileh M, Elazary R, Abu-Gazala M, Abu Gazala S, Gazala SA, Schlager A, Rivkind A, Mintz Y. Robotic-assisted enucleation of a large lower esophageal leiomyoma and review of literature. Int J Med Robot 2013; 9:253-7. [PMID: 23401224 DOI: 10.1002/rcs.1484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 01/10/2023]
Abstract
Leiomyoma is the most common benign esophageal neoplasm. Different invasive surgical approaches have been described for management of such lesions. The literature is reviewed and a robotic assisted left thoracoscopic enucleation with the patient in the right side position is described. A 40-year-old male patient, otherwise healthy, found to have a lower midiastinal mass on screening X-ray, is described. Physical examination and blood tests were within normal limits. Diagnostic work-up included: computerized tomography (CT) scanning of the chest and midiastinum that revealed a 40 × 30 mm mass of the distal esophagus, an upper gastrointestinal endoscopy showed a lower protruding esophageal submucosal mass with intact mucosa, a filling defect was apparent on esophagography. Endoscopic ultrasonography (EUS) showed the same findings, biopsies were taken and leimyoma was diagnosed. Under general anesthesia with a double-lumen endotracheal tube, the patient was positioned on his right side. A 30 robotic scope was introduced in the left 7th intercostal space on the posterior axillary line. Two 8-mm robotic trocars were inserted in the left 5th and 9th intercostals spaces on the same line. Operative field was clearly exposed and an additional 5-mm ethicon trocar was inserted. The inferior pulmonary ligament was released, the parietal pleural space opened, proximal and distal control was achieved using Penrose. The muscular layer of the lower esophagus was opened by coagulation hook, the lesion was enucleated without mucosal penetration. Intraoperative endoscopy permitted localization of the lesion and ensured mucosal integrity. The muscular layer was not closed and the chest drain was left. Total operative time was 200 min and blood loss was less than 20 mL. A Gastrograffin swallow on the first post-operative day showed good esophageal clearance and absence of leak, the patient was allowed a liquid diet. He was discharged on the third post-operative day in a good general condition, benign pathology was confirmed.
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Affiliation(s)
- Abed Khalaileh
- Hadassah Hebrew University Medical Center - General Surgery, PO Box 12000, Jerusalem, 91120, Israel
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Obuchi T, Sasaki A, Nitta H, Koeda K, Ikeda K, Wakabayashi G. Minimally invasive surgical enucleation for esophageal leiomyoma: report of seven cases. Dis Esophagus 2010; 23:E1-4. [PMID: 19207558 DOI: 10.1111/j.1442-2050.2008.00917.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Benign esophageal tumor is a rare entity, with leiomyoma being the most common lesion. We present our experience with enucleation of esophageal leiomyomas using a minimally invasive approach. Between March 1998 and June 2008, seven patients with esophageal leiomyoma underwent right thoracosopic enucleation (n=4) or laparoscopic transhiatal enucleation (n=3). A Dor (n=2) or Toupet fundoplication (n=1) were added for laparoscopic procedure. The mean tumor size was 3.9 cm (range, 1.5-5.5 cm). Tumor locations were upper (n=2), middle (n=1), and lower (n=4) thirds of the esophagus. No major morbidities including postoperative leakage or mortalities occurred. At a mean follow-up period of 60.1 months (range, 14-260 months), no evidence of recurrences were observed. Thoracoscopic and laparoscopic transhiatal enucleation for esophageal leiomyomas is a safe and feasible procedure. The optimal approaches should be tailored based on the location and size of the tumor.
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Affiliation(s)
- T Obuchi
- Department of Surgery, Iwate Medical University School of Medicine, Uchimaru Morioka, Japan.
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Robotic Fourth-Arm Enucleation of an Esophageal Leiomyoma and Review of Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:354-7. [DOI: 10.1097/imi.0b013e3181c46218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Esophageal leiomyomas are resected in symptomatic and/or malignancy-suspicious cases. Traditionally, they have been removed by laparotomy or thoracotomy and more recently by thoracoscopy and laparoscopy. Mucosal injury is reported as high as 7% of cases but may be higher in unreported general practice. Robotic technology seems to offer advantages. We describe a robotic approach that seems to minimize mobilization of the esophagus, potentially decreasing the likelihood of mucosal injury and postoperative recovery time. We review the literature to evaluate the reports of mucosal injury with the open, minimally invasive, and robotic techniques and describe our own method. To improve efficiency, we use a four-arm technique.
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Kernstine KH, Emily S, Falabella A, Ramirez NA, Anderson CA, Beblawi I. Robotic Fourth-Arm Enucleation of an Esophageal Leiomyoma and Review of Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kemp H. Kernstine
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - S. Emily
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Andres Falabella
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Natalie A. Ramirez
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Casandra A. Anderson
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
| | - Ihab Beblawi
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA USA
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Jiang G, Zhao H, Yang F, Li J, Li Y, Liu Y, Liu J, Wang J. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus 2008; 22:279-83. [PMID: 19021682 DOI: 10.1111/j.1442-2050.2008.00883.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5-10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus.
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Affiliation(s)
- G Jiang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
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Abstract
AIM OF THE STUDY To report our experience with video-assisted enucleation of esophageal leiomyomas. METHOD Retrospective analysis of six (five men and a woman) patients who underwent video-assisted submucosal tumor enucleation (4 with thoracoscopy and 2 with laparoscopy). RESULTS Only one patient had postoperative complications: a parietal hematoma at a trocar site and a fever with right pleural, resolved after pleural drainage. Outcome was satisfactory for all patients, and no relapses have been noted. CONCLUSION Video-assisted surgery offers incontrovertible advantages for the treatment of this benign pathology.
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Affiliation(s)
| | | | - Gilles Poncet
- Hôpital Edouard Herriot, Place d'Arsonval, Lyon (69)
| | - Jean Boulez
- Hôpital Edouard Herriot, Place d'Arsonval, Lyon (69)
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Akaraviputh T, Chinswangwatanakul V, Swangsri J, Lohsiriwat V. Thoracoscopic enucleation of a large esophageal leiomyoma using a three thoracic ports technique. World J Surg Oncol 2006; 4:70. [PMID: 17018158 PMCID: PMC1599730 DOI: 10.1186/1477-7819-4-70] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/04/2006] [Indexed: 11/19/2022] Open
Abstract
Background Video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantages over an open approach. Many papers have described various techniques of thoracoscopic resection. Case presentation We describe a 32-year old man who presented with intermittent dysphagia. Imaging studies showed a large esophageal leiomyoma. He underwent thoracoscopic enucleation using a three thoracic-ports technique. Conclusion Thoracoscopic enucleation can be technically performed using a three thoracic-ports technique.
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Affiliation(s)
- Thawatchai Akaraviputh
- Division of General Surgery, The Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Division of General Surgery, The Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jirawat Swangsri
- Division of General Surgery, The Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Varut Lohsiriwat
- Division of General Surgery, The Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Haraguchi S, Hioki M, Hisayoshi T, Yamashita Y, Sato M, Koizumi K, Shimizu K. Enucleation of Esophageal Leiomyoma with Azygos Continuation of the Inferior Vena Cava: Report of a Case. Surg Today 2006; 36:722-6. [PMID: 16865517 DOI: 10.1007/s00595-005-3220-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 11/15/2005] [Indexed: 11/27/2022]
Abstract
We herein report a rare case of esophageal leiomyoma in an 18-year-old woman with azygos continuation of the inferior vena cava. A submucosal tumor was located in the left wall of the esophagus behind the carina. The enlarged azygos vein made video-assisted thoracic surgery so difficult that conversion to a minithoracotomy and transection of the right superior intercostal vein were necessary to fully visualize the tumor. A pathological diagnosis revealed leiomyoma. Our experience suggests that a transection of the right superior intercostal vein is effective for the proper exposure of an esophageal tumor located behind the carina in a patient with an enlarged azygos vein.
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Affiliation(s)
- Shuji Haraguchi
- Department of Surgery, Nippon Medical School Musashi-kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
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