Safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer

doi:10.3877/cma.j.issn.1674-6899.2019.05.005

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer.

Methods

A total of 68 patients with large early esophageal cancer accepted endoscopic submucosal dissection (ESD) or endoscopic submucosal tunnel dissection (ESTD) in our center from Jan. 2018 to Aug. 2019. Based on the operation strategy, 45 patients underwent ESD and 23 patients underwent ESTD treatment. Hemorrhage, perforation, dissection speed, curative resection rate and relative clinical date of ESD and ESTD group were collected and analyzed.

Results

Delayed bleeding occurred in 1 patient (2.2%) of ESD group. There was no significant difference compared with 2 patients (8.7%) of ESTD group (P=0.545). Hemostatic forceps were used to manage bleeding successfully. No perforation was observed in ESD group and intraoperative perforation occurred in 1 patient of ESTD group. No significant difference was observed between two groups (P=0.730). The perforation was treated with fibrin sealant and tissue forceps. 40 patients (88.9%) achieved curative resection and there was no significant difference compared with 21 patients(91.3%) of ESTD group (P=1.000). The dissection speed of ESTD was significantly quicker than that of ESD group(41.8±17.3)mm²/min vs (33.2±13.4)mm²/min(P=0.027).

Conclusions

ESTD appeared to be comparable with ESD in terms of safety and effficacy for large esophageal cancer. Besides, ESTD could provide a quicker dissection speed.

Key words: Early esophageal cancer, Endoscopic submucosal dissection, Endoscopic submucosal tunnel dissection, Safety, Efficacy

Jingyuan Xiang, Enqiang Linghu, Longsong Li, Yongsheng Shi, Jiale Zou, Shasha Wang, Hong Du, Ningli Chai. Safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2019, 12(05): 272-276.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2019.05.005

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References 18

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组别	例数	性别(例)		年龄(岁， ±s)	肿瘤形态(例)
组别	例数	男	女	年龄(岁， ±s)	Ⅱa型	Ⅱb型	Ⅱc型	Ⅱa＋Ⅱc型
ESD组	45	36	9	62.4±8.2	6	7	22	10
ESTD组	23	18	5	61.6±6.2	3	4	14	2
P值	?	0.867		>0.05	0.568
组别	例数	肿瘤位置(例)			肿瘤环周情况(例)		浸润深度(例)
组别	例数	食管上段	食管中段	食管下段	>1/2至≤3/4	>3/4	上皮层	固有层	黏膜肌层	黏膜下浅层
ESD组	45	5	24	16	36	9	30	3	10	2
ESTD组	23	1	13	9	15	8	10	1	7	5
P值	?	0.647			0.183		0.095

组别	例数	性别(例)		年龄(岁， ±s)	肿瘤形态(例)
组别	例数	男	女	年龄(岁， ±s)	Ⅱa型	Ⅱb型	Ⅱc型	Ⅱa＋Ⅱc型
ESD组	45	36	9	62.4±8.2	6	7	22	10
ESTD组	23	18	5	61.6±6.2	3	4	14	2
P值	?	0.867		>0.05	0.568
组别	例数	肿瘤位置(例)			肿瘤环周情况(例)		浸润深度(例)
组别	例数	食管上段	食管中段	食管下段	>1/2至≤3/4	>3/4	上皮层	固有层	黏膜肌层	黏膜下浅层
ESD组	45	5	24	16	36	9	30	3	10	2
ESTD组	23	1	13	9	15	8	10	1	7	5
P值	?	0.647			0.183		0.095

组别	例数	病变面积(cm²， ±s)	完整切除[例(%)]	治愈性切除[例(%)]	剥离速度(mm²/min， ±s)	出血[例(%)]	穿孔[例(%)]
ESD组	45	11.3±7.6	43(95.6%)	40(88.9%)	33.2±13.4	1(2.2%)	0(0.0%)
ESTD组	23	15.0±8.6	23(100.0%)	21(91.3%)	41.8±17.3	2(8.7%)	1(4.3%)
P值	?	0.077	0.789	1.000	0.027	0.545	0.730

组别	例数	病变面积(cm²， ±s)	完整切除[例(%)]	治愈性切除[例(%)]	剥离速度(mm²/min， ±s)	出血[例(%)]	穿孔[例(%)]
ESD组	45	11.3±7.6	43(95.6%)	40(88.9%)	33.2±13.4	1(2.2%)	0(0.0%)
ESTD组	23	15.0±8.6	23(100.0%)	21(91.3%)	41.8±17.3	2(8.7%)	1(4.3%)
P值	?	0.077	0.789	1.000	0.027	0.545	0.730

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