Enucleation of esophageal submucosal tumors: a single institution's experience

Abstract

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.

Keywords: 8; CT; EGD; EGJ; EUS; GIST; IQR; SD; SMT; VATS; computed tomography; endoscopic ultrasonography; esophagogastric junction; esophagogastroduodenoscopy; gastrointestinal stromal tumor; interquartile range; standard deviation; submucosal tumor; video-assisted thoracic surgery.