Murat ULAŞ, Erdal Birol BOSTANCI, Mustafa Taner BOSTANCI, İlter ÖZER, Tahsin DALGIÇ, Özcem ÖFKELİ, Mehmet Ali ÇAPARLAR, Erol AKSOY

The results of surgical treatment of distal esophageal leiomyomatosis performed distal esophagectomy

Amaç: Leiomyomalar en sık görülen benign özofageal neoplazilerdir. Cerrahi tedavi bu tümör- lerde seçilen tedavi şeklidir. Bu çalışmada, 5 yıllık bir sürede distal özofageal leiomyoma nedeni- yle cerrahi uygulanmış 6 hastanın tedavi sonuçlarını sunduk. Çalışmadaki amacımız distal özofa- gus yerleşimli leiomyoması olup distal özofajektomi ve özofagogastrostomi uygulanmış 6 hastanınuzun dönem sonuçlarını değerlendirmekti.Yöntem: Demografik özellikler, semptomlar, tanı, histopatolojiyi içerecek şekilde klinik ve la- boratuar bulgular ve cerrahi tedavi sonuçları incelenmiştir.Bulgular: Distal özofagus yerleşimli leiomyoma nedeniyle 6 hasta ( 4 kadın, 2 erkek; ortalama yaş48.8 yıl) opere edilmiştir. Disfaji ve dispepsi en sık görülen semptomlardı. Tüm hastalara medianlaparotomi ve sağ posterolateral torakotomi ile distal özofajektomi ve özofagogastrostomi uygu- lanmıştır. Hiçbir hastada mortalite gelişmemiş olup tüm hastaların semptomlarında iyileşmeolmuştur; bir hastada pnömoni gelişmiş olup medikal olarak tedavi edilmiştir.Sonuç: Özofageal leiomyoma benign bir tümör olup büyük boyutlara ulaşınca semptomatik halegelir. Distal özofageal leiomyomalarda cerrahi rezeksiyon etkili bir yöntemdir.

Distal özofajektomi yapılan distal özofageal leiomyomatozislerde cerrahi tedavi sonuçları

Objective: Leiomyomas are the most common benign esophageal neoplasms. Surgical treatmentis the therapy of choice for such tumors. In this study, we submitted results of 6 patients with distalesophageal leiomyomas who underwent surgical treatment during a 5-year period. The aim of thecurrent study was to evaluate the long-term outcomes of patients with leiomyoma located at distalesophagus who had undergone distal esophagectomy and esophagogastrostomy.Method: Demographic features, clinical and laboratory findings including symptoms, diagnosis,histopathology, and results of surgical treatment were examined.Results: 6 patients (four women, two men; mean age 48.8y) were operated due to leiomyomalocated at the lower esophagus. The most common symptoms were dysphagia and dyspepsia. Dis- tal esophagectomy and esophagogastrostomy was performed to all patients with a median lapara- thomy and a right posterolateral thoracotomy. All patients were relieved from their symptomswithout postoperative mortality, while pneumonia was occured in one patient which is treatedmedically.Conclusions: Esophageal leiomyoma is a benign tumor which becomes symptomatic in largeseizes. Surgical resection is considered to be effective for distal esophageal leiomyomas, withoutcomplications.

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1. Mutrie CJ, Donahue DM, Wain JC, Wright CD, Gaissert HA, Gril- lo HC, Mathisen DJ, Allan JS. Esophageal leiomyoma: a 40-year experience. Ann Thorac Surg 2005; 79:1122-5.
2. Aurea P, Grazia M, Petrella F, Bazzocchi R. Giant leiomyoma of the esophagus. Eur J Cardiothorac Surg 2002; 22:1008-10.
3. Lee LS, Singhal S, Brinster CJ, Marshall B, Kochman ML, Kaiser LR, Kucharczuk JC. Current man- agement of esophageal leiomyo- ma. J Am Coll Surg 2004; 198:136-46.
4. Karagülle E,Akkaya D,Türk E, Göktürk HS, Yıldırım E, Moray G. Giant leiomyoma of the esopha- gus: A case report and review of the literature. Turk J Gastroenterol 2008; 19: 180-3.
5. Hatch GF 3rd, Wertheimer-Hatch L, Hatch KF, Davis GB, Blanchard DK, Foster RS, Skandalakis JE. Tumors of the esophagus. World J Surg 2000; 24: 401-11.
6. Lawrence SL, Sunil S, Clayton JB, Blair M, Michael LK, Larry RK. Current management of esophage- al leiomyoma. J Am Coll Surg 2004; 198: 136-46.
7. Cheng BC, Chang S, Mao ZF, Li MJ, Jie Huang, Wang ZW, Wang TS. Surgical treatment of giant esophageal leiomyoma. World J Gastroenterol 2005; 11: 4258-60.
8. Rice TW. Benign esophageal tu- mors: esophagoscopy and endo- scopic esophageal ultrasound. Semin Thorac Cardiovasc Surg 2003; 15:20-6.
9. Zaninotto G, Portale G, Constan- tini M, Rizzetto C, Salvador R, Rampado S, Pennelli G, Ancona E. Minimally invasive enucleation of esophageal leiomyoma. Surg En- dosc 2006; 20: 1904-8.
10. Peters JH, DeMeester TR. Esopha- gus and diaphragmatic hernia. In: Brunicardi FC, Andersen KD, Bil- liar RT, Dunn LD, Hunter GC, Pollock RE, eds. Schwartzs Prin- ciples of Surgery. 8th ed. New York: McGraw-Hill 2005; 906.
11. Nagashima R, Takeda H, Moto- yama T, Tsukamoto O, Takahashi T. Coexistence of superficial esophageal carcinoma and leyo- myoma: case report of an endo- scopic resection. Endoscopy 1997; 29:683-4.
12. Jang KM, Lee KS, Lee SJ, Kim EA, Kim TS, Han D, Shim YM. The spectrum of benign esophage- al lesions: imaging findings. Kore- an J Radiol 2002; 3: 199-210.
13. Asteriou C, Konstantinou D, Lalountas M,Kleontas A, Setzis K, Zafiriou G, Barbetakis N. Nine years experience in surgical approach of leiomyomatosis of Esophagus. World Journal of Surgical Oncology 2009; 7: 102.
14. Sun X, Wang J, Yang G. Surgical treatment of esophageal leiomyoma larger than 5 cm in diameter: A case report and review of the liter- ature. J Thorac Dis 2012; 4: 323-6.
15. Wang Y, Sun Y, Liu Y, Li Y, Wang Z. Transesophageal intralu- minal ultrasonography in diagnosis and differential diagnosis of esophageal leiomyoma. Zhonghua Yixue Zazhi 2002; 82: 456-8.
16. Loviscek LF, Yun JH, Park YS, Chiari A, Grillo C, Cenozb MC. Leiomyoma of the oesophagus. CIR ESP 2009; 85: 147-51.
17. Punpale A, Rangole A, Bhambhani N, Karimundackal G, Desai N, Ashwin de Souza, Pramesh CS, Jambhekar N, Mistry RC. Leiomyoma of esophagus. Ann Thorac Cardiovasc Surg 2007; 13: 78-81.
18. Priego P, Lobo E, Alonso N, Gil Olarte MA, Pérez de Oteyza J, Fresneda V. Surgical treatment of esophageal leiomyoma: an analysis of our experience. Rev Esp Enferm Dig 2006; 98: 350-8.
19. Taniguchi E, Kamiike W, Iwase K, Nishida T, Akashi A, Ohashi S. Thoracoscopic enucleation of a large leiomyoma located on the left side of the esophageal wall. Surg Endosc 1997; 11: 280-2.
20. Shin CS, Jung IS. Endoscopic re- moval of submucosal tumors: pre- procedure diagnosis, technical options, and results. Endoscopy 2005; 37: 646-54.
21. Watson TJ, Peters JH, DeMeester TR. Esophageal replacement for end-stage benign esophageal dis- ease. Surg Clin North Am 1997; 77: 1099-113.
22. Johnson WH, Fecher AM, McMahon RL, Grant JP, Pryor AD. VersaStep trocar hernia rate in unclosed fascial defects in bari- atric patients. Surg Endosc 2006; 20: 1584-6.