Wile Rachel K, Barnes Katherine E, Banks Kian C, Velotta Jeffrey B
School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
Department of Surgery, UCSF East Bay, Oakland, CA, USA; Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
Int J Surg Case Rep. 2022 Sep;98:107564. doi: 10.1016/j.ijscr.2022.107564. Epub 2022 Aug 31.
Esophageal leiomyomas are the most common benign esophageal tumors. They are typically smaller than 3 cm, but larger tumors can impede local structures to cause symptoms, including dysphagia and epigastric pain. Surgical treatment of esophageal leiomyomas has historically involved open thoracotomy, but this approach is being replaced by minimally invasive approaches, including video-assisted thoracoscopic surgery (VATS).
A 46-year-old female patient presented with upper abdominal pain. Computerized tomography (CT) scanning of the abdomen and chest revealed a large (6.0 × 4.0 × 3.0 cm) gastroesophageal junction (GEJ) mass. An endoscopic ultrasound (EUS) with fine needle aspiration confirmed diagnosis of esophageal leiomyoma. A right VATS esophageal mass resection was performed to enucleate the mass. An intraoperative EGD was performed to check mucosal integrity, ensure adequate lumen patency, and visualization and insufflation was negative for a mucosal leak. The post-operative course was unremarkable.
This case report adds to the emerging evidence that VATS can be utilized for enucleation of larger leiomyomas (>5 cm in largest dimension). Additionally, the use of direct intraoperative endoscopic evaluation via esophagoscopy suggests that larger esophageal masses could potentially be enucleated with a combined VATS and endoscopic approach.
The purpose of this report is to add to the limited literature on minimally invasive surgical treatment of a relatively large GEJ leiomyoma. This case highlights that VATS, in addition to simultaneous endoscopic visualization, is an efficacious and safe option for treatment of larger leiomyomas (>5 cm) and can be associated with minimal risk.
食管平滑肌瘤是最常见的食管良性肿瘤。它们通常小于3厘米，但较大的肿瘤会压迫局部结构而引起症状，包括吞咽困难和上腹部疼痛。历史上，食管平滑肌瘤的外科治疗涉及开胸手术，但这种方法正被包括电视辅助胸腔镜手术（VATS）在内的微创方法所取代。
一名46岁女性患者出现上腹部疼痛。腹部和胸部的计算机断层扫描（CT）显示一个大的（6.0×4.0×3.0厘米）胃食管交界（GEJ）肿物。内镜超声（EUS）引导下细针穿刺确诊为食管平滑肌瘤。进行了右侧VATS食管肿物切除术以摘除肿物。术中进行了内镜下食管诊断（EGD）以检查黏膜完整性，确保管腔通畅，且可视化和充气检查未发现黏膜渗漏。术后过程顺利。
本病例报告进一步证明了VATS可用于摘除较大的平滑肌瘤（最大直径>5厘米）。此外，术中通过食管镜进行直接内镜评估表明，较大的食管肿物可能可以通过VATS与内镜联合方法摘除。
本报告的目的是补充关于相对较大的GEJ平滑肌瘤微创外科治疗的有限文献。本病例突出表明，VATS除了同时进行内镜可视化外，是治疗较大平滑肌瘤（>5厘米）的一种有效且安全的选择，并且风险极小。
