Complications of surgical treatment for esophageal leiomyoma: a case series

Esophageal leiomyomas are the most common benign tumors of the esophagus. While surgical resection is the definitive treatment for symptomatic cases, it carries a risk of postoperative complications. This study presents a case series on the surgical management of esophageal leiomyomas, with a particular emphasis on postoperative complications and their management. This retrospective case series, conducted at the National Cancer Institute (Kyiv, Ukraine), analyzed patients who underwent surgical treatment for symptomatic esophageal leiomyoma between 2021 and 2024 and developed postoperative complications classified as Clavien-Dindo grade III or higher. Data were collected from medical records, including demographics, tumor charac­teristics, surgical details, postoperative course, complications, management strategies, and outcomes. The total number of observations was n=3. Three cases with Clavien-Dindo III-IV postoperative complications were analyzed. Comp­lications included anastomotic leakage following Ivor Lewis esophagectomy (managed with endoscopic stenting and endoscopic vacuum therapy – EVT), esophageal perforation during enucleation leading to mediastinitis (managed with stenting and endoscopic vacuum therapy), and a complex case involving hemopericardium, post-cardiac arrest syndrome, peritonitis and diaphragmatic herniation requiring multiple reinterventions. Despite the severity of these complications, multidisciplinary management led to complete recovery of all patients. Histopathological evaluation confirmed benign leiomyoma in all cases. Surgical management of esophageal leiomyomas, particularly for large tumors, is often associated with significant postoperative complications. While minimally invasive techniques may reduce these risks, they do not eliminate them entirely. Endoscopic therapy plays a critical role in the non-surgical management of anastomotic leakage and esophageal perforation. Vigilant postoperative monitoring and a multidisciplinary approach are essential for achieving favorable outcomes in these complex cases.