From the Guidelines
The management of esophageal leiomyoma should be individualized based on tumor size, location, symptomatology, and histopathology, with a preference for minimally invasive approaches, such as endoscopic resection or surgical excision, depending on the specific patient and lesion characteristics, as recommended by the most recent clinical practice update 1. The approach to managing esophageal leiomyoma depends on several factors, including the size of the lesion, histopathology, malignant potential, and presence of symptoms, as outlined in the clinical practice update on management of subepithelial lesions encountered during routine endoscopy 1.
- For small, asymptomatic leiomyomas, observation with periodic endoscopic surveillance may be appropriate, given their minimal malignant potential.
- For symptomatic patients or larger tumors, surgical intervention or endoscopic resection may be recommended, with the choice of approach depending on the specific characteristics of the patient and the lesion, as well as the available expertise and equipment, as discussed in the commentary on endoscopic full-thickness resection for the management of gastrointestinal subepithelial lesions 1.
- Minimally invasive approaches, such as video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery, are preferred for tumors in the middle and lower esophagus, while a cervical approach may be used for upper esophageal lesions.
- Endoscopic submucosal dissection or endoscopic submucosal tunnel resection may be suitable for smaller lesions, and esophagectomy is rarely needed but may be considered for very large tumors or those with concerning features.
- The long-term outcomes after complete resection are excellent, with minimal recurrence rates, highlighting the importance of a thoughtful and individualized treatment plan, as emphasized in the clinical practice update on endoscopic full-thickness resection 1.
From the Research
Management Options for Esophageal Leiomyoma
The management of esophageal leiomyoma involves several approaches, including:
- Surgical enucleation via thoracotomy or thoracoscopy 2, 3, 4, 5
- Minimally invasive surgery, such as video-assisted thoracoscopic surgery (VATS) or laparoscopy 2, 3, 6, 5
- Regular monitoring for small, asymptomatic tumors 2
Surgical Approaches
Surgical approaches for esophageal leiomyoma include:
- Thoracotomy: an open surgical approach that has been considered the standard treatment 2, 4
- Thoracoscopy: a minimally invasive approach that is increasingly used for the treatment of esophageal leiomyoma 2, 3, 5
- Laparoscopy: a minimally invasive approach that can be used for tumors located near the gastroesophageal junction 6
Considerations for Surgical Approach
Considerations for the surgical approach include:
- Tumor size: smaller tumors may be more difficult to localize and may require a more invasive approach 2, 3
- Tumor location: tumors located in the upper or middle third of the esophagus may require a right-sided approach, while those located in the lower third may require a left-sided approach 5
- Symptomatology: symptomatic tumors may require more urgent treatment, while asymptomatic tumors may be monitored regularly 2, 4
Outcomes and Complications
Outcomes and complications of surgical treatment for esophageal leiomyoma include: