The choice of operative method in a patient with large esophageal schwannoma

Background. Esophageal schwannoma is a rare spindle cell tumor. To date, only 17 cases of esophageal schwannoma have been reported, with most of them occurring in women over the age of 50 years. Surgical interventions using open (cervical approach, extirpation of the esophagus with simultaneous plasty of the gastric tube) and thoracoscopic approaches have long been considered standard methods of treating patients with nonepithelial tumors of the esophagus, but currently intraluminal endoscopic interventions are widely used. Clinical case. The patient, 64 years old, was treated at the Vishnevsky National Research Medical Center for Surgery for a large schwannoma of the esophagus measuring 32×54×90 mm. After a comprehensive examination, the patient was confirmed to have a tumor emanating from the muscular layer of the esophageal wall (echo layer 4), so this neoplasm corresponded to type IIIb according to the classification typing of nonepithelial tumors of the upper gastrointestinal tract. Results. In this clinical case, we present the use of a hybrid approach for removing a large schwannoma of the esophagus. During a control endoscopic examination 4 months after surgery, no signs of residual tumor fragments, narrowing or pathological changes in the mucosa were found in the area of the previously performed dissection. Conclusion. The use of a hybrid approach for removing a large non-epithelial tumor of the esophagus using endoscopic dissection in the submucosal layer and subsequent extraction through the cervical approach made it possible to perform organ-saving surgery, minimize the risks of possible intraoperative and postoperative complications, thereby leading to a good clinical and functional result.