Esophageal Lipoma and Liposarcoma: A Systematic Review
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SCIENTIFIC REVIEW
Esophageal Lipoma and Liposarcoma: A Systematic Review Davide Ferrari1,2 Luigi Bonavina1,2
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Daniele Bernardi2 • Stefano Siboni2 • Veronica Lazzari2 • Emanuele Asti2
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Accepted: 6 September 2020 Ó The Author(s) 2020
Abstract Background Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking. Methods A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database. Results Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy. Conclusion Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.
& Luigi Bonavina [email protected] Davide Ferrari [email protected] Daniele Bernardi [email protected] Stefano Siboni [email protected]
Emanuele Asti [email protected] 1
Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, 20133 Milan, Italy
2
Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097 Milan, Italy
Veronica Lazzari [email protected]
123
World J Surg
Introduction Esophageal lipomatous tumors are uncommonly diagnosed and account for less than 1% of all benign esophageal neoplasms [1–3]. They can present as an intramural submucosal mass, or as an intraluminal mass with a long and narrow pedicle covered by intact mucosa and tethered to the cervical esophagus. The pedicle is usually vascularized, can
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