Comparison Between Submucosal Tunneling Endoscopic Resection And Thoracoscopic Enucleation For Diameter 2-5cm Esophageal Submucosal Tumors Originating From The Muscularis Propria Layer

BackgroundEsophageal muscularis propria tumors are a class of the raised lesions originated in the muscularis propria of the esophagus,which belong to the category of digestive tract submucosal tumors(SMTs).The pathological types of esophageal muscularis propria tumors are complex and diverse,including leiomyomas,gastrointestinal stromal tumors(GISTs),schwannomas,hamartomas,etc.Although most of them are benign tumors,leiomyosarcomas or GISTs have malignant or malignant potential.Therefore,thoracotomy or laparotomy for esophageal SMTs has gradually been replaced by minimally invasive surgery represented by thoracoscopic excision and electronic endoscopic resection.With the continuous maturity and rapid development of endoscopic techniques and minimally invasive treatment.At present,follow-up or endoscopic resection is preferred for most tumors whose diameter is less than 2cm generally,and thoracotomy is generally chosen for SMTs with>5cm and horseshoe-like or circular growth around the esophagus.For tumors with a diameter of 2cm～5cm,submucosal tunneling endoscopic resection(STER)and thoracoscopic enucleation(TE)are more common treatment methods.However,there are few reports on whether there is a difference in efficacy between STER and TE.This study retrospectively analyzed and summarized the clinical data of patients with diameter 2cm～5cm esophageal lamina propria tumors treated by STER and TE in the first affiliated hospital of Zhengzhou university in recent years,in order to compare the safety and efficacy of STER and TE,and to provide some suggestions and references for the selection of surgical methods for esophageal propria muscularis tumors.ObjectiveTo evaluate the clinical value of STER and TE for diameter 2-5cm esophageal submucosal tumors originating from the muscularis propria layer.MethodsThe clinical data of 97 patients with diameter 2-5cm esophageal muscularis propria tumors who underwent STER or TE in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2020 were retrospectively analyzed,in which 57 patients underwent submucosal tunneling endoscopic resection(STER group)and 40 patients underwent thoracoscopic enucleation(TE group).The general baseline data,success rate,complete tumor resection rate,operation time,postoperative hospital stay,(intraoperative,postoperative and long-term)complications and follow-up between STER group and TE group were analyzed and compared.ResultsThe success rate of tumor resection in both methods was 100%.For 2cm～3.5cm tumors(including 3.5cm),the complete resection rates of the two groups were similar,but the average operation time and median postoperative hospital stay in the STER group were significantly shorter than those of TE group(P<0.05).For 3.5cm～5cm tumors,the rate of complete TE was significantly higher than that of STER[83.33%(15/18)vs 50%(8/16),P=0.038].There are no significant difference in operation time between the two groups[(107.69±39.90)min vs(117.33±31.32)min,P=0.436].The incidence of postoperative fever in TE group was higher than that in the STER group[61.11%(11/18)vs 18.75%(3/16),P=0.012].No matter the size of the tumor,the cost of hospitalization,the incidence of postoperative chest pain and pleural effusion in the STER group were significantly lower than that of TE group(P<0.05).Follow-up for 1-36 months,there was no residual tumor or recurrence in both groups.ConclusionFor tumors with diameter of 2.0cm～3.5cm,STER is safer and more efficient,while for tumors with diameter from 3.5cm to 5cm,TE has outstanding advantages in complete resection.