Minimally Invasive Enucleation of Esophageal Leiomyoma: Experience From a Single Institution

Esophageal leiomyoma is a rare disease, most of which are benign, and endoscopic tumor removal surgery is a widely accepted treatment method. The two surgical approaches, laparoscopic and thoracoscopic, must be selected and applied according to the tumor size and location. The study aimed to evaluate the results, feasibility, and appropriate approach of minimally invasive surgery to treat esophageal leiomyoma. Subjects and research methods: A retrospective study of 27 cases of patients who underwent endoscopic tumor removal surgery to treat esophageal leiomyoma at Cho Ray Hospital was conducted from January 2015 to April 2020. Demographic characteristics, clinical symptoms, surgical characteristics, and postoperative complications were recorded.

A total of 16 men and 11 women were included in the study, with an average age of 47.2 years (25-76 years). In total, 92.6% of patients had symptoms, the most common being dysphagia (n = 19); however, 7.4% of patients still had no symptoms. Tumor removal through right thoracoscopic surgery was performed in 18 patients; the remaining nine patients were approached through laparoscopic intra-abdominal surgery. The median tumor size in all patients is 3.0 cm (2.0-5.0 cm), with the smallest tumor being 1.2 cm and the largest tumor being 8 cm. Postoperative histopathology shows esophageal leiomyoma in 100% of cases. Three cases (11.1%) of esophageal mucosal perforation and one case (3.7%) of tracheal perforation occurred during surgery. There was no case of death or suture leak after surgery. There was one case of postoperative gastroesophageal reflux that was treated successfully with medical treatment for two weeks. The average follow-up period was 21.4 months, with no deaths or recurrences during follow-up.

Endoscopic surgery is a safe, minimally invasive method for esophageal leiomyoma removal, with laparoscopy used for tumors near the gastroesophageal junction and right thoracoscopic surgery for remaining tumors, ensuring quick patient recovery.