title: Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma.
abstract: BACKGROUND
  Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors.
  
  
  METHODS
  We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain) between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay.
  
  
  RESULTS
  Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years). Surgical enucleation was achieved in all patients. In 8 cases (61.54%) a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies), and in 5 cases (38.56%) an abdominal approach was performed (3 laparotomies and 2 laparoscopies); enucleation was carried out through a minimally invasive approach in 6 patients (46.15%). There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes) and median postoperative stay was 6.5 days (range 2-27 days). There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months) no recurrences were reported.
  
  
  CONCLUSIONS
  Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group. Paradoxically, incision pain after surgery (thoracic neuralgia) was found to be higher in the minimally invasive approach group. Nevertheless, none of the results obtained in the study reached statistical significance, probably due to the small simple size.
authors.affiliation: Cirugía General y del Aparato Digestivo, Hospital universitario Ramón y Cajal, España.
authors.forename: Diego
authors.initials: D
authors.lastname: Ramos
authors.affiliation: Cirugía General y Digestivo, Hospital Ramón y Cajal, España.
authors.forename: Pablo
authors.initials: P
authors.lastname: Priego
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Coll
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: María de los Ángeles
authors.initials: Mde L
authors.lastname: Cornejo
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Julio
authors.initials: J
authors.lastname: Galindo
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Gloria
authors.initials: G
authors.lastname: Rodríguez-Velasco
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Francisca
authors.initials: F
authors.lastname: García-Moreno
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Pedro
authors.initials: P
authors.lastname: Carda
authors.affiliation: Hospital Universitario Ramón y Cajal. Madrid.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lobo
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011182:Postoperative Care; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome