From the Research
The optimal management of esophageal leiomyoma is esophagomyotomy and enucleation (option d). This surgical approach is considered the gold standard treatment for symptomatic esophageal leiomyomas because it preserves the integrity and function of the esophagus while completely removing the tumor. The procedure involves making an incision in the muscle layer of the esophagus (myotomy) followed by careful dissection and removal of the leiomyoma (enucleation) without disrupting the esophageal mucosa.
Key Points
- This technique is particularly advantageous because it minimizes the risk of esophageal stricture, preserves normal swallowing function, and has lower morbidity compared to more extensive resections.
- Esophageal leiomyomas are benign smooth muscle tumors, and their complete removal via enucleation is typically curative with very low recurrence rates.
- More aggressive approaches like Ivor-Lewis, transhiatal, or segmental resections are unnecessarily extensive for benign disease.
- While endoscopic resection may be considered for small, intraluminal leiomyomas, it carries higher risks of perforation and incomplete removal compared to the surgical enucleation approach.
Recent Evidence
A recent study published in 2024 1 supports the use of minimally invasive enucleation for esophageal leiomyoma, with low morbidity and no mortality reported. The study highlights the importance of selecting the appropriate surgical approach based on tumor size and location.
Comparison of Surgical Approaches
Other studies have compared the outcomes of different surgical approaches for esophageal leiomyoma, including open surgery and laparoscopic surgery 2. These studies have consistently shown that enucleation is a safe and effective procedure, with low complication rates and excellent long-term outcomes.
Conclusion Not Applicable - Outcome Based Answer Only
The optimal management of esophageal leiomyoma is clearly esophagomyotomy and enucleation (option d), as it provides the best outcomes in terms of morbidity, mortality, and quality of life, as supported by the most recent and highest quality study 1.