Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Retrospective Analysis of Thoracoscopic Surgery for Esophageal Submucosal Tumors

  • Kang, Seung Ku (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Yun, Ju Sik (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Kim, Sang Hyung (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Song, Sang Yun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital) ;
  • Jung, Yochun (Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital) ;
  • Na, Kook Joo (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital)
  • Received : 2014.07.09
  • Accepted : 2014.09.23
  • Published : 2015.02.05
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Abstract

Background: Surgical enucleation is the treatment of choice for esophageal submucosal tumors (SMTs) with symptomatic, larger, or ill-defined lesions. The enucleation of SMTs has traditionally been performed via thoracotomy. However, minimally invasive approaches have recently been introduced and successfully applied. In this study, we present our experiences with the thoracotomic and thoracoscopic approaches to treating SMTs. Methods: We retrospectively reviewed 53 patients with SMTs who underwent surgical enucleation between August 1996 and July 2013. Demographic and clinical features, tumor-related factors, the surgical approach, and outcomes were analyzed. Results: There were 36 males (67.9%) and 17 females (32.1%); the mean age was $49.2{\pm}11.8$ years (range, 16 to 79 years). Histology revealed leiomyoma in 51 patients, a gastrointestinal stromal tumor in one patient, and schwannoma in one patient. Eighteen patients (34.0%) were symptomatic. Fourteen patients underwent a planned thoracotomic enucleation. Of the 39 patients for whom a thoracoscopic approach was planned, six patients required conversion to thoracotomy because of overly small tumors or poor visualization in five patients and accidental mucosal injury in one patient. No mortality or major postoperative complications occurred. Compared to thoracotomy, the thoracoscopic approach had a slightly shorter operation time, but this difference was not statistically significant ($120.0{\pm}45.6$ minutes vs. $161.5{\pm}71.1$ minutes, p=0.08). A significant difference was found in the length of the hospital stay ($9.0{\pm}3.2$ days vs. $16.5{\pm}5.4$ days, p<0.001). Conclusion: The thoracoscopic enucleation of submucosal esophageal tumors is safe and is associated with a shorter length of hospital stay compared to thoracotomic approaches.

Keywords

References

  1. Seremetis MG, Lyons WS, deGuzman VC, Peabody JW Jr. Leiomyomata of the esophagus: an analysis of 838 cases. Cancer 1976;38:2166-77. https://doi.org/10.1002/1097-0142(197611)38:5<2166::AID-CNCR2820380547>3.0.CO;2-B
  2. Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol 2000;24:211-22. https://doi.org/10.1097/00000478-200002000-00007
  3. Blum MG, Bilimoria KY, Wayne JD, de Hoyos AL, Talamonti MS, Adley B. Surgical considerations for the management and resection of esophageal gastrointestinal stromal tumors. Ann Thorac Surg 2007;84:1717-23. https://doi.org/10.1016/j.athoracsur.2007.05.071
  4. Von Rahden BH, Stein HJ, Feussner H, Siewert JR. Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc 2004;18: 924-30. https://doi.org/10.1007/s00464-003-9130-9
  5. Shin S, Choi YS, Shim YM, Kim HK, Kim K, Kim J. Enucleation of esophageal submucosal tumors: a single institution's experience. Ann Thorac Surg 2014;97:454-9. https://doi.org/10.1016/j.athoracsur.2013.10.030
  6. Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg 1995;181:257-62.
  7. Guo J, Liu Z, Sun S, Liu X, Wang S, Ge N. Ligation-assisted endoscopic enucleation for treatment of esophageal subepithelial lesions originating from the muscularis propria: a preliminary study. Dis Esophagus 2014 Mar 4 [Epub]. http://dx.doi.org/10.1111/dote.12192.
  8. Chak A. EUS in submucosal tumors. Gastrointest Endosc 2002;56(4 Suppl):S43-8. https://doi.org/10.1016/S0016-5107(02)70085-0
  9. Lee LS, Singhal S, Brinster CJ, et al. Current management of esophageal leiomyoma. J Am Coll Surg 2004;198:136-46. https://doi.org/10.1016/j.jamcollsurg.2003.08.015
  10. Everitt NJ, Glinatsis M, McMahon MJ. Thoracoscopic enucleation of leiomyoma of the oesophagus. Br J Surg 1992; 79:643. https://doi.org/10.1002/bjs.1800790715
  11. Claus CM, Cury Filho AM, Boscardim PC, Andriguetto PC, Loureiro MP, Bonin EA. Thoracoscopic enucleation of esophageal leiomyoma in prone position and single lumen endotracheal intubation. Surg Endosc 2013;27:3364-9. https://doi.org/10.1007/s00464-013-2918-3
  12. Kent M, d'Amato T, Nordman C, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg 2007;134:176-81. https://doi.org/10.1016/j.jtcvs.2006.10.082
  13. Choi SH, Kim YT, Han KN, et al. Surgical management of the esophageal leiomyoma: lessons from a retrospective review. Dis Esophagus 2010 Dec 10 [Epub]. http://dx.doi.org/10.1111/j.1442-2050.2010.01144.x.
  14. Jiang G, Zhao H, Yang F, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus 2009;22:279-83. https://doi.org/10.1111/j.1442-2050.2008.00883.x
  15. Jeon HW, Choi MG, Lim CH, Park JK, Sung SW. Intraoperative esophagoscopy provides accuracy and safety in video-assisted thoracoscopic enucleation of benign esophageal submucosal tumors. Dis Esophagus 2014 Apr 9 [Epub]. http://dx.doi.org/10.1111/dote.12220.

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