Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

Abstract

Background Surgery has been considered to be the primary approach for resection of esophageal muscularis propria tumors. With the development of endoscopic technology, new techniques such as endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) have emerged for resecting these lesions. Previous studies have demonstrated that STER might be an intriguing alternative. This study aimed to evaluate the clinical value of STER by comparing it to other resecting modules. Material/Methods Clinical outcome and data were retrospectively collected from patients with esophageal muscularis propria tumors who underwent resection either endoscopically or thoracoscopically. The clinical data were statistically analyzed. Results A total of 137 patients were enrolled. They were divided into 3 groups: a STER group (27 patients), an ESD group (42 patients), and a thoracoscopic enucleation (TE) group (68 patients). There were no significant differences among the 3 groups in gender, age, pathological type of tumors, or major adverse events (P>0.05). However, the STER group had the shortest duration of hospitalization and the lowest cost (P<0.05). Furthermore, the STER group was superior in operation time and the location of tumors to the TE group. Moreover, STER outperformed ESD in the resection of large tumors (P<0.05). Although STER had the lowest en bloc resection rate, no recurrence or metastasis was noted during a mean follow-up of 22.14 months (range 3 to 60 months). Conclusions STER is a feasible, safe, and effective approach for the resection of esophageal muscularis propria tumors ≤40 mm. We recommend STER as a potent alternative for these tumors.

Feasibility and Safety of Mark-Guided Submucosal Tunneling Endoscopic Resection for Treatment of Esophageal Submucosal Tumors Originating from the Muscularis Propria: A Single-Center Retrospective Study

“…In this study, we found that the procedure duration of mark-guided STER was shorter compared with several previous studies, whereas the en bloc resection rate of mark-guided STER was prominently higher than that of these studies [ 15 , 16 , 21 ]. However, multivariate logistic regression demonstrated that procedure duration was an independent factor associated with en bloc resection.…”

“…Several techniques, including endoscopic submucosal dissection (ESD), endoscopic submucosal enucleation (ESE), endoscopic full-thickness resection (EFR), thoracoscopic enucleation, and submucosal tunneling endoscopic resection (STER), have been proved to be effective for esophageal SMTs [10][11][12][13]. However, STER is gradually recommended because it possesses more advantages than ESD, ESE, EFR, and thoracoscopic enucleation [14][15][16]. In 2012, inspired by peroral endoscopic myotomy (POEM), STER was firstly developed to remove esophageal SMTs originating from the MP layer [17].…”

Lymph node metastasis pattern and significance of left gastric artery lymph node dissection in esophagectomy for esophageal cancers

“…In one patient with an early submucosal cancerous lesion at the thoracic esophagus in our study, the left gastric lymph nodes were fused into a big mass, which indicates the necessity of resecting the upper stomach together with its mesogastrium and left gastric artery lymph nodes besides radical resection of the cancer itself. This may suggest incomplete resection of esophageal submucosal cancer by EMR, ESD, and endoscopic full-thickness resection [ 13 – 19 , 39 – 42 ]. If the esophageal submucosal cancer was just resected locally without removing the upper stomach including the left gastric lymph nodes and mesogastrium, a high proportion of patients with esophageal submucosal carcinomas will have cancer metastasis to the left gastric lymph nodes, resulting in recurrence.…”

Recent advances in third space or intramural endoscopy

“…Common adverse events included capno-mediastinum and subcutaneous emphysema, which were managed non-operatively[ 26 ]. When compared to other resection procedures such as ESD, no difference was seen in the rates of complications between the two procedures[ 30 ]. A retrospective study evaluated 137 patients with esophageal SMTs originating from the MP layer.…”

“…However, when compared to ESD, STER had longer operation times and lower en bloc resection rates. All patients were found to be free from local recurrence and metastasis after a 22-mo follow up[ 30 ].…”