Study Of Endoscopic Multi-tunnel Mucosal Dissection In Early Large Esophageal Cancer Resection And Its Effect On Postoperative Esophageal Stenosis

Objective:To evaluate the efficacy and safety of endoscopic submucosal multi-tunnel dissection(ESMTD)in the treatment of large early esophageal cancer,and to understand its effect on the incidence of postoperative esophageal stricture.Methods:68 patients with large early esophageal cancer(diameter>3 cm,or cumulative luminal>1/2 week)were enrolled in the study,randomly assigned to the ESMTD group(n=34)and the ESD group(n=34).The ESMTD group was treated with endoscopic multi-tunnel submucosal dissection,and the ESD group was treated with endoscopic mucosal dissection(ESD).The lesion resection and intraoperative adverse events,operation time and postoperative complications were evaluated in different groups.The residual and recurrence of the lesions were observed within 12 months after operation.The incidence of postoperative esophageal stenosis was observed by telephone follow-up,and the stenosis grading was performed using the Stooler grading standard.Data statistics and analysis was performed using SPSS 22.0 software.Results:(1)There were no significant differences in baseline characteristics between personal characteristics,lesion classification,lesion diameter,smoking history and drinking history in the ESMTD group and the ESD group(P>0.05).(2)The operation time and submucosal stripping time in the ESMTD group were 88.5±13.6min and 51.6±9.4min,respectively,which were significantly lower than those in the ESD group(P<0.05).The resection rate in the ESMTD group and the ESD group was 15.1±4.3 mm2/min and 11.2±5.4 mm2/min,respectively,and ESMTD group patients were significantly faster(P=0.002).(3)The En bloc resection rate,complete resection rate and curative resection rate of patients in the ESMTD group were 100.0%,94.1%and 91.2%,respectively.The En bloc resection rate and complete resection rate in the ESMTD group were significantly higher than those in the ESD group(P<0.05),but there was no statistical difference in the curative resection rate(P=0.304).(4)There was no significant difference in intraoperative blood loss and hemorrhagic grading between ESMTD group and ESD group(P>0.05).The grade of myometrial injury and wound basal injury in ESMTD group were significantly lower than those in ESD group(P<0.05).The cumulative incidence of perforation,delayed bleeding,postoperative infection,and chest pain in the ESMTD and ESD groups were 14.7%and 35.3%,and ESMTD group was significantly lower(P=0.049).(5)The incidence of postoperative esophageal stenosis in the ESMTD group and the ESD group were 29.4%(10/34)and 55.9%(19/34),and the ESMTD group was significantly lower(P=0.027).The results of the test showed that the postoperative stenosis grade was significantly lower in the ESMTD group than in the ESD group(P=0.026).Log-rank test results showed that the incidence of stenosis was significantly lower in the ESMTD group than in the ESD group(?2=5.715,P=0.017).(6)Multivariate Cox regression analysis showed that the surgical method(ESMTD or ESD),lesion diameter and operative time were independent influencing factors of postoperative esophageal stenosis.ESMTD can reduce the incidence of postoperative stenosis.Conclusions:(1)ESMTD provides a highly operational technique for the treatment of large esophageal cancer in early stage,which effectively improves the intraoperative view,shortens the operation time,improves the rate of disease stripping,and reduces the patient's esophagus mucosal and muscular layer damage.(2)ESMTD can significantly improve the resection efficiency of large esophageal cancer in early stage,and it is of great significance to improve the long-term prognosis of patients.(3)ESMTD can significantly reduce the incidence of postoperative esophageal stenosis and the need for a second operation,which has potential clinical significance.