Thoracoscopic versus endoscopic resection for esophageal leiomyoma: a propensity score-matched retrospective cohort study.

Abstract

Introduction: Esophageal leiomyoma is the most common benign mesenchymal tumor of the esophagus. Minimally invasive management is performed by thoracoscopic surgery or endoscopic resection, but comparative evidence remains limited. This study evaluated perioperative outcomes and treatment-selection patterns for thoracic and endoscopic resection.

Methods: Patients with pathologically confirmed leiomyoma who underwent resection between January 2015 and September 2023 were retrospectively reviewed. Patients with malignant components, biopsy/fine-needle aspiration only, or incomplete data were excluded. A 1:1 propensity score matching analysis was performed using nearest-neighbor matching with a caliper of 0.1, matching age, sex, tumor location, and maximal tumor diameter.

Results: A total of 1,348 patients were included in the primary analysis: 132 underwent minimally invasive thoracic surgery and 1,216 underwent endoscopic resection. In the endoscopic group, 54.5% underwent endoscopic submucosal dissection and 45.5% underwent submucosal tunneling endoscopic resection. In the MIS group, 62 patients (47.0%) received intraoperative endoscopic assistance. Endoscopic resection was associated with shorter operative duration (41.9 ± 39.9 vs 114.8 ± 71.0 min, p < 0.001) and shorter postoperative hospital stay (median 2.0 vs 5.0 days, p < 0.001), whereas minimally invasive thoracic surgery was used for larger tumors (median 5.0 vs 1.3 cm, p < 0.001). After matching, 113 pairs were analyzed. Endoscopic resection remained associated with shorter operative duration (73.7 ± 62.9 vs 111.6 ± 61.5 min, p = 0.009) and shorter postoperative hospital stay (median 3.0 vs 5.0 days, p < 0.001). In the matched cohort, nasogastric tube placement and delayed stay of 5 days or longer were less common after endoscopic resection.

Conclusions: Endoscopic resection was associated with faster postoperative recovery in patients with esophageal leiomyoma, whereas thoracic surgery remained important for larger tumors and complex lesions. These findings support a size- and location-oriented treatment strategy rather than a universal preference for either approach.