Enucleation of Esophageal Submucosal Tumors: A Single Institution's Experience

doi:10.1016/j.athoracsur.2013.10.030

The Annals of Thoracic Surgery

Volume 97, Issue 2, February 2014, Pages 454-459

https://doi.org/10.1016/j.athoracsur.2013.10.030 Get rights and content

Background

Esophageal submucosal tumors (SMTs) are usually benign, and surgical enucleation is widely accepted as the treatment of choice. The goals of this study were to investigate the surgical outcomes after enucleation of esophageal SMTs and to establish the feasibility of video-assisted thoracoscopic enucleation.

Methods

We performed a retrospective review of 87 patients who underwent enucleation of esophageal SMTs between 1995 and 2011 at Samsung Medical Center.

Results

There were 59 men and 28 women in the study group, with a mean age of 43.3 years (range, 20–73 years). Fifty-eight (67%) patients were asymptomatic. Among the remaining patients, the most common symptom was dysphagia (n = 12). Transthoracic approaches were used in 79 patients, including 63 patients who underwent video-assisted thoracoscopic enucleation. Transabdominal approaches were performed in 8 patients. Pathologic diagnosis included leiomyoma (n = 78 [89.7%]), gastrointestinal stromal tumors (GISTs) (n = 5 [5.7%]), schwannoma (n = 3 [3.4%]), and hemangioma (n = 1 [1.1%]). The thoracoscopic enucleation group had a significantly shorter median hospital stay compared with the thoracotomy groups (5 versus 6 days; p = 0.013). Overall, there were 2 postoperative leaks, including in 1 patient who underwent reoperation after enucleation. With the exception of 2 patients, there was no other major complications. One patient underwent esophagectomy for tumor recurrence after enucleation of GISTs.

Conclusions

Overall, surgical outcomes were excellent after enucleation. The thoracoscopic approach was feasible for most patients and was correlated with a shorter hospital stay. However, careful management is warranted after enucleation of GISTs considering the recurrence risk.

Section snippets

Study Population

Eighty-seven patients who underwent enucleation of esophageal SMTs between February 1995 and November 2011 at Samsung Medical Center were included in this study. Their medical records were reviewed retrospectively. The Institutional Review Board of the Samsung Medical Center approved this study and waived the requirement for informed consent.

Preoperative Evaluation

Patients underwent comprehensive preoperative evaluations, which included esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS),

Patient Characteristics

Patient characteristics are described in Table 1. There were 59 men and 28 women, with a mean age of 43.4 years (range, 20–73 years). The majority of the tumors arose in the middle (n = 36 [41.4%]) and lower thirds of the esophagus or at the EGJ (n = 35 [40%]). Fifty-eight (67%) patients were asymptomatic and their tumors were discovered incidentally by screening EGD during health examinations. The most common symptom that patients reported was dysphagia (n = 12). The mean tumor size in all

Comment

The primary goal of this study was to investigate surgical outcomes after enucleation of esophageal SMTs. Our study indicated that enucleation was sufficient surgical management for most SMTs, with low morbidity. The thoracoscopic approach is also feasible for most patients, with shorter hospital stays compared with the thoracotomy group (5 versus 6 days; p = 0.013). Even though the mean tumor size was larger in the thoracotomy group than in the VATS group (6.5 versus 4.0 cm; p = 0.002), we

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Original articleGeneral thoracicEnucleation of Esophageal Submucosal Tumors: A Single Institution's Experience

Background

Methods

Results

Conclusions

Section snippets

Study Population

Preoperative Evaluation

Patient Characteristics

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Am Coll Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Leiomyomata of the esophagus. An analysis of 838 cases

Cancer

Original article
General thoracic
Enucleation of Esophageal Submucosal Tumors: A Single Institution's Experience