title: Enucleation of esophageal submucosal tumors: a single institution's experience.
abstract: BACKGROUND
  Esophageal submucosal tumors (SMTs) are usually benign, and surgical enucleation is widely accepted as the treatment of choice. The goals of this study were to investigate the surgical outcomes after enucleation of esophageal SMTs and to establish the feasibility of video-assisted thoracoscopic enucleation.
  
  
  METHODS
  We performed a retrospective review of 87 patients who underwent enucleation of esophageal SMTs between 1995 and 2011 at Samsung Medical Center.
  
  
  RESULTS
  There were 59 men and 28 women in the study group, with a mean age of 43.3 years (range, 20-73 years). Fifty-eight (67%) patients were asymptomatic. Among the remaining patients, the most common symptom was dysphagia (n=12). Transthoracic approaches were used in 79 patients, including 63 patients who underwent video-assisted thoracoscopic enucleation. Transabdominal approaches were performed in 8 patients. Pathologic diagnosis included leiomyoma (n=78 [89.7%]), gastrointestinal stromal tumors (GISTs) (n=5 [5.7%]), schwannoma (n=3 [3.4%]), and hemangioma (n=1 [1.1%]). The thoracoscopic enucleation group had a significantly shorter median hospital stay compared with the thoracotomy groups (5 versus 6 days; p=0.013). Overall, there were 2 postoperative leaks, including in 1 patient who underwent reoperation after enucleation. With the exception of 2 patients, there was no other major complications. One patient underwent esophagectomy for tumor recurrence after enucleation of GISTs.
  
  
  CONCLUSIONS
  Overall, surgical outcomes were excellent after enucleation. The thoracoscopic approach was feasible for most patients and was correlated with a shorter hospital stay. However, careful management is warranted after enucleation of GISTs considering the recurrence risk.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sumin
authors.initials: S
authors.lastname: Shin
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: choi.smcts@gmail.com.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D055815:Young Adult
keywords: 8; CT; EGD; EGJ; EUS; GIST; IQR; SD; SMT; VATS; computed tomography; endoscopic ultrasonography; esophagogastric junction; esophagogastroduodenoscopy; gastrointestinal stromal tumor; interquartile range; standard deviation; submucosal tumor; video-assisted thoracic surgery