title: Retrospective analysis of thoracoscopic surgery for esophageal submucosal tumors.
abstract: BACKGROUND
  Surgical enucleation is the treatment of choice for esophageal submucosal tumors (SMTs) with symptomatic, larger, or ill-defined lesions. The enucleation of SMTs has traditionally been performed via thoracotomy. However, minimally invasive approaches have recently been introduced and successfully applied. In this study, we present our experiences with the thoracotomic and thoracoscopic approaches to treating SMTs.
  
  
  METHODS
  We retrospectively reviewed 53 patients with SMTs who underwent surgical enucleation between August 1996 and July 2013. Demographic and clinical features, tumor-related factors, the surgical approach, and outcomes were analyzed.
  
  
  RESULTS
  There were 36 males (67.9%) and 17 females (32.1%); the mean age was 49.2±11.8 years (range, 16 to 79 years). Histology revealed leiomyoma in 51 patients, a gastrointestinal stromal tumor in one patient, and schwannoma in one patient. Eighteen patients (34.0%) were symptomatic. Fourteen patients underwent a planned thoracotomic enucleation. Of the 39 patients for whom a thoracoscopic approach was planned, six patients required conversion to thoracotomy because of overly small tumors or poor visualization in five patients and accidental mucosal injury in one patient. No mortality or major postoperative complications occurred. Compared to thoracotomy, the thoracoscopic approach had a slightly shorter operation time, but this difference was not statistically significant (120.0±45.6 minutes vs. 161.5±71.1 minutes, p=0.08). A significant difference was found in the length of the hospital stay (9.0±3.2 days vs. 16.5±5.4 days, p<0.001).
  
  
  CONCLUSIONS
  The thoracoscopic enucleation of submucosal esophageal tumors is safe and is associated with a shorter length of hospital stay compared to thoracotomic approaches.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine.
authors.forename: Seung Ku
authors.initials: SK
authors.lastname: Kang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine.
authors.forename: Ju Sik
authors.initials: JS
authors.lastname: Yun
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine.
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine.
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Song
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital.
authors.forename: Yochun
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine.
authors.forename: Kook Joo
authors.initials: KJ
authors.lastname: Na
keywords: Enucleation; Esophagus, surgery; Submucosal tumors of the esophagus; Thoracoscopy