Efficacy And Safety Of Endoscopic Submucosal Tunnel Dissection For Early Superficial Esophageal Cancer

ObjectivePatients with early superficial esophageal cancer were enrolled in the study.The clinical randomized controlled method was used to evaluate the efficacy and safety of endoscopic submucosal tunnel dissection(ESTD),and the tips of operation techniques were discussed,then to provide technical support to improve the prognosis of early esophageal cancer and reduce postoperative complications and recurrence.Methods74 patients with early esophageal cancer who were treated in the First Affiliated Hospital of Soochow University were enrolled,randomly divided into the ESTD group and the cESD group,37 cases each.The ESTD group underwent submucosal tunnel dissection and the cESD group underwent endoscopic mucosal dissection(ESD).The main indicators evaluated in this study were the time of lesion resection(ie,time from lesion marking to resection completed,including hemostasis time);Secondary indicator included lesion dissection rate,submucosal dissection time,intraoperative index(bleeding,myometrial injury,wound surface grade),lesion resection(complete resection rate,curative resection rate),intraoperative bleeding,perforation and postoperative complications.Data analysis was performed using SPSS 19.0 software.Results(1)The mean diameter of lesions in the ESTD group and the cESD group were 26.6±5.6 mm and 25.7±6.4 mm,respectively.In the ESTD group,17 cases were severe high-grade intraepithelial neoplasia/in situ carcinoma,20 cases of esophageal cancer;In the ESD group,21 cases were severe high-grade intraepithelial neoplasia/in situ carcinoma,16 cases of esophageal cancer lesions;there were no statistical differences in lesion location,endoscopic classification(Paris typing),pathological type,and lesion diameter distribution between ESTD group cESD group(P>0.05).(2)The total operation time was 58.2±9.4min and 76.3±11.2min in the ESTD group and the cESD group(P<0.001).The mean rate of lesion exfoliation in the two groups was 17.3±5.1 mm2/min and 12.1 ±3.4 mm2/min,which was statistically significant(P<0.001).The total operation time and submucosal stripping time of the ESTD group were lower than those of the cESD group(P<0.001).(3)The mean bleeding volume in the ESTD group and the cESD group was 63.4±18.3 ml and 81.3±20.4 ml,respectively(P<0.001),and the intraoperative hemorrhage grade and the degree of damage to the muscularis propria were significantly lower in the ESTD group than in the cESD group(P=0.038).(4)The curative resection rate was 94.6%(35/37)and 73.0%(27/37)in the ESTD group and the cESD group.The curative resection rate was significantly higher in the ESTD group than in the cESD group(P=0.032).(5)There was no perforation and delayed bleeding in the ESTD group.Esophageal stricture occurred in 18 patients.The incidence of esophageal stenosis in the ESTD group and the cESD group were 13.5%and 35.1%,respectively,and the difference was significant(P=0.043).The incidence of pectoralgia was lower than that of the cESD group(P=0.047).There was no significant difference in the incidence of postoperative infection and delayed type bleeding between the two groups(P>0.05).Conclusion(1)ESTD could significantly shorten the proportion of lesions and improve the rate of lesion removal;(2)ESTD could effectively improve the rate of curative resection,reduce esophageal damage,and improve prognosis;(3)ESTD could reduce intraoperative bleeding,postoperative stenosis and pectoralgia,has higher safety which is of great value for early esophageal cancer.