Thoracoscopic Management of Benign Submucosal Tumors

  • Daniel C. Thomas
  • Anthony W. KimEmail author


Benign submucosal tumors of the esophagus are rare, with leiomyoma accounting for the majority of cases. Although the management of small asymptomatic benign submucosal tumors is debated, tumors that are symptomatic, large, or require a pathologic diagnosis to rule out malignancy should be removed, preferably by tumor enucleation. The thoracoscopic approach has been increasingly used for benign esophageal submucosal tumors and is similar to the open thoracotomy approach in many aspects without compromising successful exposure, mobilization, or tumor enucleation. Thoracoscopic enucleation has been demonstrated to be a technically feasible and safe alternative to the traditional thoracotomy, with shorter hospital stays, less postoperative pain, and no difference in functional outcomes.


Esophagus Submucosal Benign tumor Leiomyoma Video-assisted thoracoscopic surgery Enucleation 


  1. 1.
    Hatch GF 3rd, Wertheimer-Hatch L, Hatch KF, Davis GB, Blanchard DK, Foster RS Jr, et al. Tumors of the esophagus. World J Surg. 2000;24:401–11.CrossRefGoogle Scholar
  2. 2.
    KM FMA. Benign tumors, cysts, and duplications of the esophagus. In: Shields TW, JR LC, Feins CE, et al., editors. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 7e.Google Scholar
  3. 3.
    Mutrie CJ, Donahue DM, Wain JC, Wright CD, Gaissert HA, Grillo HC, et al. Esophageal leiomyoma: a 40-year experience. Ann Thorac Surg. 2005;79:1122–5.CrossRefGoogle Scholar
  4. 4.
    von Rahden BH, Stein HJ, Feussner H, Siewert JR. Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc. 2004;18:924–30.CrossRefGoogle Scholar
  5. 5.
    Roviaro GC, Maciocco M, Varoli F, Rebuffat C, Vergani C, Scarduelli A. Videothoracoscopic treatment of oesophageal leiomyoma. Thorax. 1998;53:190–2.CrossRefGoogle Scholar
  6. 6.
    Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg. 1995;181:257–62.PubMedGoogle Scholar
  7. 7.
    Seremetis MG, Lyons WS, VC dG, Peabody JW Jr. Leiomyomata of the esophagus. An analysis of 838 cases. Cancer. 1976;38:2166–77.CrossRefGoogle Scholar
  8. 8.
    Choong CK, Meyers BF. Benign esophageal tumors: introduction, incidence, classification, and clinical features. Semin Thorac Cardiovasc Surg. 2003;15:3–8.CrossRefGoogle Scholar
  9. 9.
    Paruch JZM, Ferguson MK. Resection of benign tumors of the esophagus. In: Sugarbaker DJ, Bueno R, Colson YL, Jaklitsch MT, Krasna MJ, Mentzer SJ, et al., editors. Adult chest surgery. New York: McGraw-Hill Education; 2009. p. 2e.Google Scholar
  10. 10.
    Samphire J, Nafteux P, Luketich J. Minimally invasive techniques for resection of benign esophageal tumors. Semin Thorac Cardiovasc Surg. 2003;15:35–43.CrossRefGoogle Scholar
  11. 11.
    Lee LS, Singhal S, Brinster CJ, Marshall B, Kochman ML, Kaiser LR, et al. Current management of esophageal leiomyoma. J Am Coll Surg. 2004;198:136–46.CrossRefGoogle Scholar
  12. 12.
    Arnorsson T, Aberg C, Aberg T. Benign tumours of the oesophagus and oesophageal cysts. Scand J Thorac Cardiovasc Surg. 1984;18:145–50.CrossRefGoogle Scholar
  13. 13.
    Hanel K, Talley NA, Hunt DR. Hemangioma of the esophagus: an unusual cause of upper gastrointestinal bleeding. Dig Dis Sci. 1981;26:257–63.CrossRefGoogle Scholar
  14. 14.
    Palazzo L, Landi B, Cellier C, Roseau G, Chaussade S, Couturier D, et al. Endosonographic features of esophageal granular cell tumors. Endoscopy. 1997;29:850–3.CrossRefGoogle Scholar
  15. 15.
    Coutinho DSS, Soga J, Yoshikawa T, Miyashita K, Tanaka O, Sasaki K, et al. Granular cell tumors of the esophagus: a report of two cases and review of the literature. Am J Gastroenterol. 1985;80:758–62.PubMedGoogle Scholar
  16. 16.
    Akiyama S, Kataoka M, Horisawa M, Inoue S, Sakai M, Ito K, et al. Lipoma of the esophagus—Report of a case and review of the literature. Jpn J Surg. 1990;20:458–62.CrossRefGoogle Scholar
  17. 17.
    Nishikawa K, Omura N, Yuda M, Tanaka Y, Matsumoto A, Tanishima Y, et al. Video-assisted thoracoscopic surgery for localized neurofibroma of the esophagus: case report and review of the literature. Int Surg. 2013;98:461–5.CrossRefGoogle Scholar
  18. 18.
    Yoon YH, Kim KH, Baek WK, Kim JT, Son KH, Han JY, et al. Lymphangioma of the esophagus: surgical treatment. Ann Thorac Surg. 2004;78:e51–e3.CrossRefGoogle Scholar
  19. 19.
    Everett C, Volberg F, Ulshen M, Murray G. Intramural esophageal hamartoma: A report of two cases and review of the literature. Gastrointest Radiol. 1980;5:317–9.CrossRefGoogle Scholar
  20. 20.
    Kim AW, Korst RJ, Port JL, Altorki NK, Lee PC. Giant cavernous hemangioma of the distal esophagus treated with esophagectomy. J Thorac Cardiovasc Surg. 2007;133:1665–7.CrossRefGoogle Scholar
  21. 21.
    Rijcken E, Kersting CM, Senninger N, Bruewer M. Esophageal resection for giant leiomyoma: report of two cases and a review of the literature. Langenbeck’s Arch Surg. 2008;394:623.CrossRefGoogle Scholar
  22. 22.
    Yang PS, Lee KS, Lee SJ, Kim TS, Choo I-W, Shim YM, et al. Esophageal leiomyoma: radiologic findings in 12 patients. Korean J Radiol. 2001;2:132–7.CrossRefGoogle Scholar
  23. 23.
    Rice TW. Benign esophageal tumors: esophagoscopy and endoscopic esophageal ultrasound. Semin Thorac Cardiovasc Surg. 2003;15:20–6.CrossRefGoogle Scholar
  24. 24.
    Everitt NJ, Glinatsis M, McMahon MJ. Thoracoscopic enucleation of leiomyoma of the oesophagus. Br J Surg. 1992;79:643.CrossRefGoogle Scholar
  25. 25.
    Kent M, d’Amato T, Nordman C, Schuchert M, Landreneau R, Alvelo-Rivera M, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg. 2007;134:176–81.CrossRefGoogle Scholar
  26. 26.
    Aurea P, Grazia M, Petrella F, Bazzocchi R. Giant leiomyoma of the esophagus. Eur J Cardiothorac Surg. 2002;22:1008–10.CrossRefGoogle Scholar
  27. 27.
    Jobe BA, Hunter JG, Watson DI. Esophagus and diaphragmatic hernia. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al., editors. Schwartz’s principles of surgery. 10e ed. New York: McGraw-Hill Education; 2014.Google Scholar
  28. 28.
    Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg. 2005;241:1016–21. discussion 21–3CrossRefGoogle Scholar
  29. 29.
    Nguyen NT, Reavis KM, El-Badawi K, Hinojosa MW, Smith BR. Minimally invasive surgical enucleation or esophagogastrectomy for benign tumor of the esophagus. Surg Innov. 2008;15:120–5.CrossRefGoogle Scholar
  30. 30.
    Jiang G, Zhao H, Yang F, Li J, Li Y, Liu Y, et al. Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 cases. Dis Esophagus. 2009;22:279–83.CrossRefGoogle Scholar
  31. 31.
    Bardini R, Asolati M. Thoracoscopic resection of benign tumours of the esophagus. Int Surg. 1997;82:5–6.PubMedGoogle Scholar
  32. 32.
    Palanivelu C, Rangarajan M, Madankumar MV, John SJ, Senthilkumar R. Minimally invasive therapy for benign tumors of the distal third of the esophagus – a single institute’s experience. J Laparoendosc Adv Surg Tech A. 2008;18:20–6.CrossRefGoogle Scholar
  33. 33.
    Fisichella PM, Soper NJ, Pellegrini CA, Patti MG. Surgical management of benign esophageal disorders. London: Springer; 2014.CrossRefGoogle Scholar
  34. 34.
    Luh S-P, Hou S-M, Fang C-C, Chen C-Y. Video-thoracoscopic enucleation of esophageal leiomyoma. World J Surg Oncol. 2012;10:52.CrossRefGoogle Scholar
  35. 35.
    Obuchi T, Sasaki A, Nitta H, Koeda K, Ikeda K, Wakabayashi G. Minimally invasive surgical enucleation for esophageal leiomyoma: report of seven cases. Dis Esophagus. 2010;23:E1–4.CrossRefGoogle Scholar
  36. 36.
    Vallbohmer D, Holscher AH, Brabender J, Bollschweiler E, Gutschow C. Thoracoscopic enucleation of esophageal leiomyomas: a feasible and safe procedure. Endoscopy. 2007;39:1097–9.CrossRefGoogle Scholar
  37. 37.
    Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.CrossRefGoogle Scholar
  38. 38.
    Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89:931–7.CrossRefGoogle Scholar
  39. 39.
    Wu JT, Mattox KL, Wall MJ Jr. Esophageal perforations: new perspectives and treatment paradigms. J Trauma. 2007;63:1173–84.CrossRefGoogle Scholar
  40. 40.
    Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259:852–60.CrossRefGoogle Scholar
  41. 41.
    Zaninotto G, Portale G, Costantini M, Rizzetto C, Salvador R, Rampado S, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc. 2006;20:1904–8.CrossRefGoogle Scholar
  42. 42.
    Banki F, Mason RJ, DeMeester SR, Hagen JA, Balaji NS, Crookes PF, et al. Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg. 2002;236:324–36.CrossRefGoogle Scholar
  43. 43.
    Watson TJ, DeMeester TR, Kauer WK, Peters JH, Hagen JA. Esophageal replacement for end-stage benign esophageal disease. J Thorac Cardiovasc Surg. 1998;115:1241–7. discussion 7-9CrossRefGoogle Scholar
  44. 44.
    Nguyen NT, Alcocer JJ, Luketich JD. Thoracoscopic enucleation of an esophageal leiomyoma. J Clin Gastroenterol. 2000;31:89.CrossRefGoogle Scholar
  45. 45.
    Boffa DJ, Dhamija A, Kosinski AS, Kim AW, Detterbeck FC, Mitchell JD, et al. Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer. J Thorac Cardiovasc Surg. 2014;148:637–43.CrossRefGoogle Scholar
  46. 46.
    Shigemura N, Yim AP. Variation in the approach to VATS Lobectomy: effect on the evaluation of surgical morbidity following VATS lobectomy for the treatment of stage I non–small cell lung cancer. Thorac Surg Clin. 2007;17:233–9.CrossRefGoogle Scholar

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© SAGES 2019

Authors and Affiliations

  1. 1.Yale School of Medicine, Yale UniversityNew HavenUSA
  2. 2.Department of SurgeryUniversity of Southern California Keck School of MedicineLos AngelesUSA

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