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 esophageal mucosa and normal esophageal function while completely removing the tumor. The procedure involves making a longitudinal incision in the muscle layer over the tumor (myotomy), followed by careful dissection and removal of the leiomyoma from the submucosa without disrupting the mucosal layer. This technique is particularly appropriate because esophageal leiomyomas are benign, well-encapsulated tumors that arise from the muscularis propria layer of the esophagus. More aggressive resections like Ivor-Lewis, transhiatal, or segmental esophagectomy are unnecessarily radical for these benign lesions and carry higher morbidity. Endoscopic resection is generally limited to smaller, intraluminal lesions and may not be suitable for typical leiomyomas that are often intramural.
The enucleation approach offers excellent outcomes with low recurrence rates, minimal postoperative complications, and preservation of normal esophageal function, as supported by recent studies such as 1, which demonstrated the safety and efficacy of minimally invasive enucleation of esophageal leiomyoma. The study found that laparoscopic and thoracoscopic approaches can be used to remove esophageal leiomyomas with low morbidity and no mortality.
Some key points to consider when performing esophagomyotomy and enucleation include:
- The use of intraoperative endoscopy to confirm mucosal integrity and prevent esophageal perforation, as described in 2
- The importance of reapproximating the muscle layers after tumor enucleation to prevent the development of a pseudodiverticulum, as noted in 2 and 3
- The potential for minimally invasive surgery to reduce hospital stay and recovery period, as reported in 1 and 4
Overall, esophagomyotomy and enucleation is the recommended treatment for esophageal leiomyoma due to its excellent outcomes, low recurrence rates, and minimal postoperative complications, as supported by the most recent and highest quality study 1.