Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors influencing operative time

doi:10.3877/cma.j.issn.1674-0785.2019.09.007

Abstract

Abstract:

Objective

To evaluate the efficacy of endoscopic submucosal tunnel dissection (ESTD) in the treatment of esophageal intramucosal and submucosal cancer and explore the factors influencing operation time.

Methods

A total of 133 patients with esophageal intramucosal and submucosal carcinomas treated at our hospital from November 2015 to December 2018 were retrospectively analyzed. Among them, 80 patients were treated by endoscopic submucosal dissection (ESD; group A) and 53 patients were treated by ESTD (group B). Logistic regression analysis was used to identify the factors influencing operation time.

Results

There was no significant difference between the two groups in the rates of total excision and radical excision (P>0.05); the total operation time and the time of submucosal dissection in group B were significantly less than those of group A (P<0.05). The speed of submucosal dissection in group B was significantly higher than that in group A (P<0.05). There was no significant difference in the rates of bleeding, fever, and chest pain after operation between the two groups (P>0.05). The rates of muscle layer injury and bleeding during operation in group B were significantly lower than those of group A (P<0.05). Logistic regression analysis showed that ESTD application and lesion area<9 cm² were independent influencing factors of operation time (P<0.05).

Conclusion

ESTD for esophageal intramucosal and submucosal carcinomas can effectively shorten total operation time and submucosal dissection time, improve the speed of mucosal dissection, and reduce the incidence of intraoperative myometrial injury and intraoperative bleeding, with a similar overall resection effect to ESD. Operation time is closely related to the type of endoscopy and the area of lesion.

Key words: Endoscopic submucosal tunnel dissection, Esophageal neoplasms, Intramucosal cancer, Submucosal cancer, Operation time

Yuxin Wang, Jijun Zhu, Yunyun Liu, Yan Wang, Wei Liu, Fengjuan Cai, Xiaoyan Wang. Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors influencing operative time[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(09): 675-679.

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Figures/Tables 5

References 16

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组别	例数	男/女（例）	年龄（岁）	病灶面积（cm²）	病灶位置（例）			病理类型（例）
组别	例数	男/女（例）	年龄（岁）	病灶面积（cm²）	上1/3	中1/3	下1/3	黏膜内癌	黏膜下癌
A组	80	63/17	59.8±7.3	9.23±1.08	5	41	34	62	18
B组	53	41/12	59.3±7.1	9.70±1.16	2	28	23	40	13
统计值	?	χ²=0.36	t=0.678	t=0.841	χ²=0.363			χ²=0.073
P值	?	0.849	0.496	0.292	0.916			0.786

组别	例数	男/女（例）	年龄（岁）	病灶面积（cm²）	病灶位置（例）			病理类型（例）
组别	例数	男/女（例）	年龄（岁）	病灶面积（cm²）	上1/3	中1/3	下1/3	黏膜内癌	黏膜下癌
A组	80	63/17	59.8±7.3	9.23±1.08	5	41	34	62	18
B组	53	41/12	59.3±7.1	9.70±1.16	2	28	23	40	13
统计值	?	χ²=0.36	t=0.678	t=0.841	χ²=0.363			χ²=0.073
P值	?	0.849	0.496	0.292	0.916			0.786

组别	例数	整块切除率	根治性切除率
A组	80	80（100）	74（92.50）
B组	53	53（100）	52（98.11）
χ²值	?	-	2.015
P值	?	1.000	0.157

组别	例数	整块切除率	根治性切除率
A组	80	80（100）	74（92.50）
B组	53	53（100）	52（98.11）
χ²值	?	-	2.015
P值	?	1.000	0.157

组别	例数	总手术时间（min）	黏膜下剥离时间（min）	黏膜下剥离速度（cm²/min）
A组	80	47.0（32.0~115.0）	35.0（27.0~93.0）	0.35（0.20~0.45）
B组	53	35.0（24.0~72.0）	30.0（14.0~55.0）	0.45（0.25~0.60）
Z值	?	-2.10	-2.88	-2.71
P值	?	0.036	0.025	0.031

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