Benign esophageal tumors are rare, accounting for only 1% of esophageal tumors. The age of onset is smaller than that of esophageal cancer, the symptoms progress slowly and the disease duration is long. The most common benign esophageal tumor is smooth muscle tumor, which accounts for about 90%, and there are also polyps, lipomas, fibrolipomas, papillomas, etc., which originate from the mucosal and submucosal layers. Esophageal smooth muscle tumors are most commonly seen in middle-aged men. Smooth muscle tumors are mostly located in the lower and middle segments of the esophagus, and most of them are solitary. Smooth muscle tumors originate from the muscle layer of the esophageal wall and grow slowly into and out of the lumen of the esophagus, while the mucosa remains intact and thus does not cause vomiting of blood. The tumor is round, oval or horseshoe-shaped, with an intact envelope, tough, grayish-white, swirling structure, 2 to 5 cm in diameter, but sometimes up to 10 cm or more, encircling long segments of the esophagus. Esophageal smooth muscle tumor may not present clinical symptoms for a long time, but is discovered accidentally during barium meal X-ray examination of the gastrointestinal tract. When the smooth muscle tumor grows larger than 5 cm, it may present post-sternal fullness, painful pressure and mild swallowing obstruction. Barium esophagogram X-ray can show smooth and neat round or oval filling defect with sharp angle between its upper and lower edges and normal esophageal wall junction, and esophageal mucosal folds in tumor area are flattened by tumor and disappeared but not destroyed. The tumor may be seen to move up and down with the esophagus during swallowing motion. The asymptomatic and small cases of esophageal smooth muscle tumor can be followed up regularly for observation, and there is no need to perform surgery urgently. If the tumor is large and clinically symptomatic or asymptomatic but causes anxiety after discovery of the tumor, removal of the esophageal smooth muscle tumor is recommended. After entering the chest through the right or left thoracic incision, the mediastinal pleura is incised and the esophagus is exposed, and the smooth muscle tumor can be removed outside the mucosa by longitudinal incision of the muscular layer. If the mucosa is broken during the operation, interrupted internal sutures are required, and then the muscle layer is sutured and covered with mediastinal pleura. In cases of huge smooth muscle tumors encircling the esophagus, partial esophagectomy and esophagogastric anastomosis are required.