Clinical Analyses of Submucosal Tunneling Endoscopic Resection for the Treatment of Submucosal Tumor Arising from Muscularis Propria at Esophagus and Cardia

Abstract

Introduction: The usual treatment of esophageal SMT from muscularis propria was surgery. STER is used to treat the muscularis propria tumor since its appeareace. To evaluate its feasibility and safety, our study contains 2 parts. The first one is a retrospective study:summarize the data of patients of upper gastrointestinal submucosal tumors arising from muscularis propria who underwent the treatment of submucosal tunneling endoscopic resection(STER). The second one is a prospective study that compares the STER with the video-assisted thoracic surgery(VATS) in operation time, complication rates, costs and so on. Methods: 1. Ccollected all data of patients of upper gastrointestinal submucosal tumors originating from muscularis propria admitted to Chinese PLA general hospital between 2012 and 2014 and furthermore treated with STER. The sex ratio of patients, ages, operation time, tumor size, pathological diagnosis were analyzed. Prospectively analyse the data of patients of esophageal SMT arising from muscularis propria admitted to Chinese PLA general hospital after 2014.7.30 and furthermore managed by STER and VATS. To compare the two group in operation time, costs, complication rates and so on. Results: 1. Sixty-four patients and 65 tumors were involved in the retrospective study, successful resection rate is 96.97%.46 males and 18 females, aged 22 to 69 years old (mean age 47.48 years old).The tumor size ranged from 0.4 to 5cm (median is 1.7cm), During the operation, two patients developed cardiac mucosal tear(CMT), one pneumoperitonium, one mediastinal emphysema, two pneumothorax, six subcutaneous emphysema. Eight patients developed fever after operation.No one developed severe bleeding, perforation and even death. With follow-up 4 to 28 months, no recurrence, stricture and diverticulum occured. 2. 19 patients and 21 tumors is involved in the prospective study. 18 males and 1 female, mean age is 46.7±8.9 year old. The tumor size ranged from 1.2 to 5.5cm. The baseline data of the two groups is no difference. Then the comparation of the two groups in feasibility is no difference either. But the number of person of STER group required and the blood loss is significantly less than the VATS group. Conclusion: 1. Submucosal tunneling endoscopic resection (STER) for the submucosal tumors arising from muscularis propria at upper gastrointestinal tract is safe and effective. 2. The STER and VATS have no significant difference to treat the tumor under 3.5cm.