Minimally invasive resection of esophageal leiomyoma: 24 year experience.

INTRODUCTION

Esophageal leiomyoma is the most common benign submucosal esophageal tumor, with enucleation as the preferred treatment. This study evaluates our institution's experience with minimally invasive surgical management of esophageal leiomyoma.

METHODS

We conducted a retrospective cohort study of patients who underwent surgery for histologically confirmed esophageal leiomyoma between 2000 and 2024. Patients with other submucosal tumors (i.e. GISTs), esophageal carcinoma, or those who underwent endoscopic resection were excluded.

RESULTS

53 patients underwent surgical resection for esophageal leiomyoma during the 24-year study period. Surgical approaches included thoracoscopic enucleation in 33 patients (62.3%), laparoscopic enucleation in 13 patients (24.5%), thoracoscopic conversion to open enucleation in 5 patients (9.4%), and minimally invasive esophagectomy in 2 patients (3.8%). The mean tumor size was 4.92 cm. Perioperative complication rates were infrequent: intraoperative mucosal injury occurred in 3 patients (5.7%), and Clavien-Dindo grade ≤ II postoperative complications were reported in 3 patients (5.7%). Notably, there were no instances of major morbidity or postoperative leaks. The mean hospital length of stay was 4 days. Among patients who underwent thoracoscopic enucleation (mean tumor size: 4.6 cm), dysphagia was the most common presenting symptom (68.8%). In the laparoscopic group (mean tumor size: 3.3 cm), reflux was predominant (76.9%), and 7 patients (53.8%) underwent concomitant fundoplication (4 Nissen, 2 Dor, 1 Toupet). Persistent reflux occurred in 4 patients who did not have concurrent anti-reflux procedures (30.8% of laparoscopic cases), with two patients (15.4%) requiring subsequent fundoplications.

CONCLUSIONS

Minimally invasive enucleation may offer a safe and effective treatment for esophageal leiomyoma. Thoracoscopic enucleation may be suitable for proximal to mid-esophageal tumors, while laparoscopic enucleation with anti-reflux surgery may be advisable for distal tumors within 3 cm proximal to the gastrointestinal junction to reduce postoperative reflux and the need for future surgical interventions.