What is not necessary when considering surgery for a large esophageal leiomyoma?

When evaluating the need for surgery for a large esophageal leiomyoma, a preoperative biopsy is generally considered unnecessary. This is primarily because the imaging studies, such as CT or endoscopic ultrasound, can typically provide enough information to confirm the presence of a leiomyoma. These tumors are generally benign and characteristic in their presentation. Additionally, the need for a biopsy is often bypassed since resection is usually definitive and diagnostic in these scenarios.

In contrast, a thorough risk assessment is crucial prior to any surgical intervention. Understanding the patient's overall health status, comorbidities, and the potential risks associated with surgery helps in making informed decisions and preparing adequately for the procedure.

Regarding the surgical approach, while a thoracotomy may be a standard approach for accessing the esophagus, it is not an absolute necessity in every case and could vary based on the size and location of the tumor, as well as the surgeon's preference and experience.

Finally, a pneumonectomy, which involves the removal of an entire lung, is not relevant in the management of esophageal leiomyomas, as these tumors are not related to lung pathology and do not necessitate such invasive procedures.

Thus, the focus on surgical management emphasizes that a preoperative biopsy is