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Surgical enucleation of submucosal esophageal tumors: Feasibility of minimally invasive approach and comparison with open approach
Ju Sik Yun1, Sang Gi Oh1, Kook Joo Na2, Sang Yun Song2.
1Chonnam National University Hospital, Gwangju, Korea, Republic of, 2Chonnam National University Hwasun Hospital, Jeollanamdo, Korea, Republic of.

OBJECTIVE: Surgical enucleation is the treatment of choice for submucosal esophageal tumors (SMTs) in symptomatic, larger, or ill-defined lesions. Enucleation of SMTs has traditionally been performed via thoracotomy. However, recently minimally invasive approachs (thoracoscopic and laparoscopic techniques) have been introduced and successfully applied. We present here our experiences with the thoracotomy and thoracoscopic approach to SMTs.
METHODS: Between August 1996 and May 2012, we retrospectively reviewed 47 patients with SMTs who underwent surgical enucleation. All (n=34) patients underwent the thoracoscopic enucleation as the initial approach Since 2006 it has been first introduced to SMTs in our institution. Demographic and clinical features, tumor-related factors, surgical outcomes were analyzed.
RESULTS: There were 30 males (63.8%) and 17 females (36.2%); mean age was 50.0 ± 12.2 years (range, 16 to 79 years). Histology revealed leiomyoma in 45 patients, GIST in 1 patient and schwannoma in 1 patient. 17 patiens (36.2%) were symptomatic. The tumors were located in the upper (n=17), middle (n=18), and lower (n=12) thirds of the esophagus. 13 patients underwent planned thoracotomic enucleation. Of 34 patients planned for thoracoscopic approach, 5 patients required conversion to thoracotomy because of too small tumors or poor visualization in 4 patients and accidental mucosal injury in 1 patient. There was no mortality. And there were no major postoperative complications including postoperative leakage. Compared to thoracotomy, thoracoscopic approach had a little shorter operation time but without significancy (Thoracoscopy vs thoracotomy = 131.8 ± 48.1 vs 168.8 ± 73.7 minutes, p=0.128). And there was a significant difference in the length of hospital stay (Thoracoscopy vs thoracotomy = 9.5 ± 3.0 vs 17.0 ± 4.9 days, p<0.001).
CONCLUSIONS: Thoracoscopic enucleation of submucosal esophageal tumors is technically safe and associated with a shorter length of hospital stay compared with thoracotomic approaches. Thoracoscopic approach is recommended as a standard procedure in experienced centers.


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