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J Thorac Cardiovasc Surg 2007;134:176-181
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Minimally invasive resection of benign esophageal tumors

University of Pittsburgh Medical Center, Pittsburgh, Pa.

Received for publication July 24, 2006; revisions received October 2, 2006; accepted for publication October 9, 2006.

^_* Address for reprints: James Luketich, MD, Director, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Suite C-800, 200 Lothrop Street, Pittsburgh, PA 15213. (Email: luketichjd{at}msx.upmc.edu).

Objective: Benign tumors of the esophagus are uncommon. Traditionally, resection has required thoracotomy or laparotomy. In this study we present our experience with resection of these tumors using a minimally invasive approach.

Methods: A retrospective review of patients who underwent resection of benign esophageal tumors between 1990 and 2005 was conducted. Operative approach, tumor size, and outcomes after surgery were recorded.

Results: Twenty patients were identified (leiomyoma: n = 15; stromal tumor: n = 3; granular cell tumor, n = 1; schwannoma: n = 1). Four patients underwent an open approach (right thoracotomy); the remainder were resected using minimally invasive techniques (thoracoscopy, n = 9; laparoscopy, n =7). There were no postoperative leaks or other major complications after surgery. Two patients required repair of a mucosal injury during resection. Mean tumor size in the open group was 8.1 cm (range 7–10 cm) compared with 3.5 cm (range 0.9–8 cm) in the minimally invasive group. Median length of stay was 5.5 days in the open group compared with 2.75 days in the minimally invasive group. Five patients subsequently required fundoplication for worsening (n = 3) or new-onset (n = 2) gastroesophageal reflux disease after tumor resection.

Conclusions: Minimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches. Although no specific cutoff for size could be identified, most tumors greater than 7 cm were removed by thoracotomy. The subsequent development of reflux may be related to the esophageal myotomy required for resection.

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