Rare benign esogastric tumors. Contemporary tactics of diagnosis and treatment

Abstract

Background. Leiomyomas are rare benign mesenchymal GI tumors, with low malignity rate that are often asymptomatic, casually discovered, but can suddenly result in massive hemorrhage. Esophageal leiomyomas represent 8% of the total esophageal tumors, gastric leiomyomas account for 2,5% of all gastric neoplasms. Objective of the study. Analysis of the efficacy of diagnosis and surgical treatment of patients with esogastric leiomyomas. Material and Methods. In the Surgical department No 4 between 2010-2020 there have been treated 6 patients with benign esogastric tumors, of which 3 – gastric leiomyomas, 2 esophageal, 1 jejunal, that were histopathologically confirmed. Asymptomatic – 2 cases, with epigastric pain – 1 case, with postprandial regurgitation – 2 cases, and one case complicated with gastrointestinal hemorrhage. Results. On one patient traditional laparotomy was performed, videothoracoscopy- 1 patient, videothoracoscopy + conversion to thoracotomy- 1 patient, laparoscopy3 patients. Postoperative evolution for everyone was favorable, with a short stay in hospital for those with laparoscopic approach. Postoperative complications were not detected. Conclusion. Large tumors are more prone to ulcerations, that may result in severe hemorrhage. The surgical approach to each patient is individual. The minimally invasive surgery represents the ˮGold-standardˮ of treatment. Introducere. Leiomioamele sunt tumori mezenchimale benigne rare, cu malignitate joasă, deseori asipmtomatice, descoperite întâmplător, dar care se pot complica brusc cu hemoragii masive. Leiomioamele esofagiene reprezintă 8% din toate tumorile esofagului. Dintre neoplasmele gastrice, leiomiomul reprezintă 2,5%. Scopul lucrării. Analiza eficacității diagnosticului și tratamentului chirurgical al pacienţilor cu leiomiom esogastric. Material și Metode. În cadrul clinicii de chirurgie Nr 4 în perioada de activitate 2010-2020, au fost tratați 6 pacienți cu tumori benigne rare esogastrice dintre care 3 cazuri de leiomiom gastric, 2 esofagiene, 1 jejunal care au fost confirmate histologic. Asimptomatice au fost 2 cazuri, cu dureri epigastrice – 1 caz, cu regurgitații postalimentare – 2 cazuri și un caz complicat cu hemoragie gastrointestinală. Rezultate. Un pacient a suferit tratament chirurgical prin laparotomie, videotoracoscopie – 1 pacient, videotoracoscopie + conversie la toracotomie –1 pacient, laparoscopic – 3 pacienți. Evoluția postoperatorie la toți a decurs favorabil cu o durată scurtă de ședere la cei operați prin abord laparoscopic. Complicații postoperatorii absente. Concluzii. Tumorile de dimensiuni mari sunt mai susceptibile la asocieri de ulcerații ceea ce poate provoca hemoragii masive. Abordul chirurgical în leiomiomul gastric este individualizat. Tratamentul minim invaziv chirurgical reprezintă un „Gold-standardˮ.