Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series

Caterina Froiio,Peter Philipp Grimminger,Carolina Mann,Giovanni Capovilla,Evangelos Tagkalos,Hauke Lang,Edin Hadzijusufovic,Felix Berlth

doi:10.1007/s13304-022-01247-z

Abstract

Esophageal submucosal tumors (SMTs) are rare heterogenous clinical entities. The surgical resection can be performed in different surgical approaches. However, the robotic surgical strategy is poorly documented in the treatment of SMTs. We present our series of operated esophageal SMTs approached via robotic-assisted surgery. Six patients with symptomatic esophageal submucosal tumors underwent robotic surgery within a 3-year period. The performed procedures were robotic-assisted enucleation, robotic esophagectomy (RAMIE) and reverse hybrid robotic esophagectomy. Patients’ clinical data, intra/postoperative outcomes, and histopathological features were retrieved from the institution’s prospective database. Five of six patients were scheduled for upfront surgery: four underwent robotic enucleation (three leiomyoma and one suspected GIST) and one underwent reverse hybrid robotic esophagectomy (suspected GIST). One patient, diagnosed with GIST, was treated with neoadjuvant Imatinib therapy, before undergoing a RAMIE. No major intra-operative complications were recorded. Median length of stay was 7 days (6–50), with a longer post-operative course in patients who underwent esophagectomy. Clavien–Dindo > 3a complications occurred in two patients, aspiration pneumonia and delayed gastric emptying. The final histopathological and immuno-histochemical diagnosis were leiomyoma, well-differentiated GIST, low-grade fibromyxoid sarcoma and Schwannoma. Robotic-assisted surgery seems to be a promising option for surgical treatment strategies of benign or borderline esophageal submucosal tumors.

Highlights

Esophageal submucosal tumors (SMTs) are rare, accounting for less than 1% of all esophageal neoplasms [1]
Six patients with esophageal submucosal tumors were robotically operated over a 3-year period
We reported our case series of esophageal SMTs approached via robotic-assisted surgery, describing the surgical technical details, the intraoperative and postoperative outcomes

Summary

Introduction

Esophageal submucosal tumors (SMTs) are rare, accounting for less than 1% of all esophageal neoplasms [1]. They arise from mesenchymal, muscle, vascular, nerve or glandular cells, defining a histopathological heterogeneous group of tumors with different clinical implications. Neither endoscopic nor radiological imaging techniques can always deliver an accurate clinical differential diagnosis between benign and malignant lesions, and the pre-operative histopathological definition is not always conclusive [5]. This challenge, combined with the low incidence of SMTs leads to a non-standardized management in terms of diagnostic and therapeutic treatment pathways. Surgical resection of esophageal submucosal tumors (enucleation, resection up to subtotal esophagectomy), represents the mainstay in the treatment of suspected malignant tumors and of large symptomatic lesions [6–8]

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Conclusion