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Description Giant esophageal leiomyomas (GEL) are challenging benign conditions to treat in a total minimally invasive way. Here we show the management of a complete thoracoscopic enucleation (TE) of three giant esophageal masses in three different patients. Not only the size of these masses but mostly the position of them made the indication for TE borderline. Methods Every patient underwent a full diagnostic pre-op workup with CT scan, PET and EUS guided biopsies to rule out any malignancy. In this video, we show a full thoracoscopic approach with the patient on the left flank in a semi-prone/prone position and under general anesthesia without lung exclusion. We use a 3 trocars approach and low pressure(8mmHg) CO2 insufflation during the whole procedure. The dissection of the mass is carefully performed to keep the whole mucosal layer undamaged and minimizing the incision in the muscular layer. Careful reconstruction of the muscular layer is a mandatory step at the end of the procedure. Azygos vein resection is performed depending on the mass location. We extract the mass in a bag by enlarging the incision of the inferior scapular trocar. The integrity of the mucosal layer was constantly checked during the procedure either by direct endoscopic vision or by insufflation of air through a nasogastric tube. Results All the patients had an uneventful post-operative course, upper-GI series showed no leak, no stricture nor dilatation of the esophagus. On POD 4 a soft diet was administered. Conclusions Esophageal leiomyomas are a rare condition; the ones larger than 10cm are defined as GEL and they represent the 17% of the total. While, in advanced centers, Total TE for small leiomyomas is a standard of care, GELs are usually managed by open surgery, and in many cases, esophagectomy has to be performed. In our series of five consecutive GELs, located in the upper esophagus, TE proved to be safe and effective in all the patients. Disclosure All authors have declared no conflicts of interest.

Background Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC. Methods A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed. Results A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. Conclusion Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended. Disclosure All authors have declared no conflicts of interest.

BACKGROUND Infusion of radiolabeled monoclonal antibodies (MAbs) directly into a tumor or into the site of disease after surgery concentrates a high quantity of antibody and radioisotope in the neoplastic tissue. The strong irradiation delivered by this method can result in control of high grade malignant gliomas. METHODS Antitenascin MAbs BC-2 and BC-4 labeled with 131I (mean dose, 1998 MBq) were injected into 105 patients with malignant glioma by means of an indwelling catheter. Multiple courses (up to six) were given. The patients underwent MAb treatment after their tumors were minimized by surgery, radiotherapy, and, in recurrent lesions, a second operation. Data is presented in this article for 62 evaluable patients with high grade malignant gliomas (58 glioblastomas and 4 anaplastic astrocytomas), of which 31 were newly diagnosed tumors and 31 were recurrent lesions. In 40 cases the disease was minimal at the time of MAb injection, and in 22 cases a macroscopic remnant was present. RESULTS There were very few adverse effects, all of which were minor. The treatment yielded a significant extension of patients' median survival (23 months) and of the disease free time to relapse (12 months). Favorable objective responses were recorded as follows: 9 partial responses, 3 complete responses, and 20 with no evidence of disease. A response rate of 51.6% was calculated for all assessable patients. The most important factor in obtaining beneficial outcomes was limited extension of the neoplasm at the time of therapy. CONCLUSIONS In selected patients, locoregional radioimmunotherapy can be included in a multimodal strategy to control high grade malignant gliomas and produce favorable results. Cancer 1997; 80:2733-42. © 1997 American Cancer Society.