Esophageal Duplication Cyst -- A Guest Case in Robotic and Computer-Assisted Surgery From the University of Nebraska Medical Center

Chad Ringley, MD; Victor Bochkarev, MD; Dmitry Oleynikov, MDSeries Editors: Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD


November 02, 2006

Approach to Therapy

Complete excision of the cyst is the treatment of choice. Several reports in the literature suggest that observation is the appropriate strategy, including one case report of a patient who remained asymptomatic during 13 years of follow-up.[9] However, the largest series with patient observation suggested that most adults with mediastinal cysts develop symptoms and/or complications.[6,20] In a reported series of 86 patients, St-Georges and colleagues[20] noted that with prolonged observation, 72% of patients became symptomatic and/or experienced complications. Mediastinal cysts can be complicated by hemorrhage, infection, rapid cyst enlargement, cyst rupture, and malignant transformation.[10,11,12,13,14] The most commonly reported malignancy is squamous followed by adenocarcinoma.[14,15] This is a rare event with no specific data on the risk for transformation. All presumed mediastinal cysts should be resected because an operation can be more hazardous when the cyst becomes symptomatic and because definitive diagnosis can be established only on the surgical specimen. Thus, any additional invasive diagnostic attempts, such as EUS or CT-guided needle aspiration/biopsy, do not provide further information, but may cause cyst or mediastinal infection.

Which of the following surgical approaches can be used to treat esophageal duplication cysts?

  1. Laparoscopic/robotic transhiatal excision of the cyst

  2. Thoracoscopic cystectomy

  3. Laparotomy, transhiatal esophageal dissection, and cystectomy

  4. Endoluminal transesophageal cystectomy

  5. All of the above

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