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Surgical management of the esophageal leiomyoma: lessons from a retrospective review

Authors

  • S. H. Choi,

    1. Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul
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  • Y. T. Kim,

    Corresponding author
    1. Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul
    2. Cancer Research Institute, The Transplantation Research Center, Seoul National University College of Medicine, Seoul
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  • K. N. Han,

    1. Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul
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  • Y. J. Ra,

    1. Department of Thoracic and Cardiovascular Surgery, Busan National University Yangsan Hospital, Busan, Republic of Korea
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  • C. H. Kang,

    1. Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul
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  • S. W. Sung,

    1. Cancer Research Institute, The Transplantation Research Center, Seoul National University College of Medicine, Seoul
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  • J. H. Kim

    1. Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Seoul
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  • Subject: General Thoracic Surgery.

Dr Young T. Kim, MD, Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Cancer Research Institute, The Transplantation Research Center, Seoul National University College of Medicine, 103 Daehangno Jongno-gu, Seoul 110744, Korea. Email: ytkim@snu.ac.kr

SUMMARY

Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. We analyzed our surgical outcomes by comparing thoracotomy and the thoracoscopic approach. A retrospective review was performed of patients who underwent surgical resection of esophageal leiomyomas at the Seoul National University Hospital. Between 1982 and 2005, 63 patients were identified (male, n= 39; female, n= 24) at a mean age of 44.5 years. Thirty-two patients (51%) were symptomatic. Forty-five patients underwent thoracotomy, and 18 patients were resected using thoracoscopy. There was no mortality. The mean length of hospital stay was 10.3 days in the open group and 8.0 days in thoracoscopy group. Intraoperative mucosal repair was required in eight patients. Preoperative endoscopic mucosal biopsy within 1 month was identified as a risk factor for mucosal injury. Among the 11 patients with tumors less than 1.5 cm in size, thoracoscopic resection was attempted on four patients, and three out of the four cases required conversions to thoracotomy.

Minimally invasive surgery for esophageal leiomyoma can be performed with good results. Our results suggest that the thoracoscopic approach should be considered as a standard surgical method for the treatment of esophageal leiomyoma. However, in cases of small tumors less than 1.5 cm in size, localization of the tumor may be difficult, and if asymptomatic, a regular monitoring should be considered as an alternative approach in such small tumors.

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