Advertisement

Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer

Abstract

Background

Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35 mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma.

Methods

We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35–55 mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS.

Results

A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P > 0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P < 0.05). No recurrence was noted in the STER and VATS groups during a mean follow-up of 10.9 and 30.8 months, respectively.

Conclusions

The treatment efficacy was comparable between the STER and VATS for esophageal leiomyoma of 35–55 mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2

References

  1. 1.

    Punpale A, Rangole A, Bhambhani N, Karimundackal G, Desai N, de Souza A, Pramesh CS, Jambhekar N, Mistry RC (2007) Leiomyoma of esophagus. Ann Thorac Cardiovasc Surg 13(2):78–81

  2. 2.

    Kim GH (2012) Endoscopic resection of subepithelial tumors. Clin Endosc 45(3):240–244

  3. 3.

    Shin S, Choi YS, Shim YM, Kim HK, Kim K, Kim J (2014) Enucleation of esophageal submucosal tumors: a single institution’s experience. Ann Thorac Surg 97(2):454–459

  4. 4.

    Shi Q, Zhong YS, Yao LQ, Zhou PH, Xu MD, Wang P (2011) Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 74(6):1194–1200

  5. 5.

    Lu J, Lu X, Jiao T, Zheng M (2014) Endoscopic management of upper gastrointestinal submucosal tumors arising from muscularis propria. J Clin Gastroenterol 48(8):667–673

  6. 6.

    Inoue H, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Eleftheriadis N, Maselli R, Kudo S (2012) Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 44(3):225–230

  7. 7.

    Xu MD, Cai MY, Zhou PH, Qin XY, Zhong YS, Chen WF, Hu JW, Zhang YQ, Ma LL, Qin WZ, Yao LQ (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199

  8. 8.

    Liu BR, Song JT, Kong LJ, Pei FH, Wang XH, Du YJ (2013) Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia. Surg Endosc 27(11):4354–4359

  9. 9.

    Ye LP, Zhang Y, Mao XL, Zhu LH, Zhou X, Chen JY (2014) Submucosal tunneling endoscopic resection for small upper gastrointestinal subepithelial tumors originating from the muscularis propria layer. Surg Endosc 28(2):524–530

  10. 10.

    Gong W, Xiong Y, Zhi F, Liu S, Wang A, Jiang B (2012) Preliminary experience of endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors. Endoscopy 44(3):231–235

  11. 11.

    Wang L, Ren W, Zhang Z, Yu J, Li Y, Song Y (2013) Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc 27(11):4259–4266

  12. 12.

    Lu J, Jiao T, Zheng M, Lu X (2014) Endoscopic resection of submucosal tumors in muscularis propria: the choice between direct excavation and tunneling resection. Surg Endosc 28(12):3401–3407

  13. 13.

    Wang H, Tan Y, Zhou Y, Wang Y, Li C, Zhou J, Duan T, Zhang J, Liu D (2015) Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Eur J Gastroenterol Hepatol 27(7):776–780

  14. 14.

    Chen H, Xu Z, Huo J, Liu D (2015) Submucosal tunneling endoscopic resection for simultaneous esophageal and cardia submucosal tumors originating from the muscularis propria layer (with video). Dig Endosc 27(1):155–158

  15. 15.

    Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 25(5):479–489

  16. 16.

    Tsai SJ, Lin CC, Chang CW, Hung CY, Shieh TY, Wang HY, Shih SC, Chen MJ (2015) Benign esophageal lesions: endoscopic and pathologic features. World J Gastroenterol 21(4):1091–1098

  17. 17.

    Salah W, Faigel DO (2014) When to puncture, when not to puncture: submucosal tumors. Endosc Ultrasound 3(2):98–108

  18. 18.

    Kumbhari V, Saxena P, Azola A, Messallam AA, El ZMH, Khashab MA (2015) Submucosal tunneling endoscopic resection of a giant esophageal leiomyoma. Gastrointest Endosc 81(1):219–220

  19. 19.

    Tan Y, Liu D (2015) En bloc submucosal tunneling endoscopic resection for a giant esophageal leiomyoma. Gastrointest Endosc 82(2):399

  20. 20.

    Wang X, Tan Y, Zhang J, Liu D (2015) Risk factors for gas-related complications of peroral endoscopic myotomy in achalasia. Neth J Med 73(2):27–32

  21. 21.

    Tan Y, Zhu H, Lv L, Liu D (2015) Enlarging an accidental mucosotomy to facilitate tumor extraction during submucosal tunneling endoscopic resection for a giant esophageal leiomyoma. Gastrointest Endosc. doi:10.1016/j.gie.2015.07.024

  22. 22.

    Ng JJ, Chiu PW, Shabbir A, So JB (2015) Removal of a large, 40-mm, submucosal leiomyoma using submucosal tunneling endoscopic resection and extraction of specimen using a distal mucosal incision. Endoscopy 47(Suppl 1):E232-3

Download references

Acknowledgments

This study was funded by Development and Reform Commission of Hunan Province (XFGTZ2014713).

Author information

Correspondence to Deliang Liu.

Ethics declarations

Disclosures

Deliang Liu, Yuyong Tan, Liang Lv, Tianying Duan, Junfeng Zhou, Yao Tang and Dongzi Peng declare no conflict of interests for this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 137288 kb)

Supplementary material 1 (MP4 137288 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tan, Y., Lv, L., Duan, T. et al. Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer. Surg Endosc 30, 3121–3127 (2016). https://doi.org/10.1007/s00464-015-4567-1

Download citation

Keywords

  • Esophageal leiomyoma
  • Gastrointestinal surgical procedures
  • Submucosal tunneling endoscopic resection
  • Video-assisted thoracoscopic surgery