Surg Endosc. 2025 Oct 13. doi: 10.1007/s00464-025-12263-6. Online ahead of print.
ABSTRACT
BACKGROUND AND STUDY AIM: Super minimally invasive surgery (SMIS) via endoscopic submucosal tunnel dissection (ESTD) has shown promising preliminary efficacy for the treatment of large early esophageal cancer (EEC). This study reports the short- and long-term outcomes of both single- and double-tunnel ESTD for large EEC.
PATIENTS AND METHODS: All 90 patients with large EEC underwent ESTD at three hospitals between December 2013 and March 2024. We divided patients into two groups (single-tunnel SMIS and double-tunnel SMIS).
MAIN OUTCOME MEASUREMENTS: rates of en bloc resection, complete resection (R0 resection), curative resection, dissection speed and complications were evaluated as short-term outcomes. Overall survival, local or distant recurrence, and postoperative stricture rates were evaluated as long-term outcomes.
RESULTS: For all patients, the en bloc and R0 resection rates were 97.8% and 67.8%, respectively. Post-ESTD bleeding and fever were detected in 8.9% and 17.8% of the procedures, respectively. Postoperative stenosis and recurrence occurred in 54 patients (60.0%) and 7 patients (9.5%), respectively. Among the 90 patients with different circumferential-extent lesions, those who received a double-tunnel ESTD procedure (n = 54) underwent dissection faster than those who received a single-tunnel ESTD procedure (n = 36, 0.25 vs. 0.19 cm2/min, P = 0.012). No statistically significant differences were observed between the two groups in terms of short-term postoperative complications, postoperative esophageal stenosis, survival or recurrence rates (P > 0.05). Multivariate regression analysis revealed that whole-circumferential lesions were an independent risk factor for technical difficulties.
CONCLUSION: ESTD was effective for treating large early esophageal carcinoma. Compared with single-tunnel ESTD, double-tunnel ESTD has a faster resection speed, and there was no significant difference in short-term postoperative complications or long-term follow-up results. Therefore, double-tunnel ESTD is safe, reliable and more efficient in the treatment of large EEC.
PMID:41083611 | DOI:10.1007/s00464-025-12263-6
