PMID- 29340815 OWN - NLM STAT- MEDLINE DCOM- 20191031 LR - 20220331 IS - 1432-2218 (Electronic) IS - 0930-2794 (Linking) VI - 32 IP - 7 DP - 2018 Jul TI - Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer: a randomized controlled trial. PG - 3364-3372 LID - 10.1007/s00464-018-6057-8 [doi] AB - BACKGROUND AND AIMS: Surgical resection is considered the first treatment option for submucosal tumors (SMTs) originating from the muscularis propria layer while submucosal tunneling endoscopic resection (STER) is proved to be a safe and effective method for treating SMTs. This study aimed to compare video-assisted thoracoscopic enucleation (VATE) with STER for treating esophageal SMTs. METHODS: Sixty-six patients with small esophageal SMTs were prospectively randomized from July 2014 to December 2015. After exclusion of 8 patients, 58 subjects scheduled for STER or VATE were enrolled. Clinicopathological, endoscopic, and adverse events (AEs) data were collected and analyzed between STER and VATE. RESULTS: Forty-six males and 12 females with a mean age of 46.1 +/- 9.4 years were randomized to the STER (n = 30) and VATE (n = 28) groups, respectively. Demographics and lesion features were similar between the two groups. Median procedure time was shorter in the STER group than the VATE group (44.5 vs. 106.5 min, P < 0.001); cost was lower in the STER group (4499.46 vs. 6137.32 USD, P = 0.010). Median decrease in hemoglobin levels post-procedure was - 1.6 g/L in the STER group and 14.7 g/L after VATE (P = 0.001). Lower postoperative pain scores were found in the STER group compared with the VATE group (2 vs. 4, P < 0.001). No recurrent or residual tumors were found in either group. En bloc resection rates, complete resection rates, hospital times, and post-procedure AEs were similar between two groups. The en bloc resection rates for SMTs < 20.0 mm were 100% in both groups while STER achieved only 71.4% en bloc resection rate for SMTs >/= 20.0 mm. CONCLUSION: STER and VATE are comparably effective for esophageal SMTs; however, STER is superior to VATE with shorter operation time and decreased cost, and seems safer than VATE. STER is recommended for SMTs < 20.0 mm while VATE is recommended for SMTs with a transverse diameter > 35.0 mm. Clinical trail registration statement: This study is registered at http://www.chictr.org.cn/showproj.aspx?proj=4814 . The registration identification number is ChiCTR-TRC-14004759. The registration date is April 30, 2014. FAU - Chai, Ningli AU - Chai N AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Du, Chen AU - Du C AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Gao, Ying AU - Gao Y AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Niu, Xiaotong AU - Niu X AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Zhai, Yaqi AU - Zhai Y AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Linghu, Enqiang AU - Linghu E AUID- ORCID: 0000-0003-4506-7877 AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. linghuenqiang@vip.sina.com. FAU - Liu, Yang AU - Liu Y AD - Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China. FAU - Yang, Bo AU - Yang B AD - Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China. FAU - Lu, Zhongsheng AU - Lu Z AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Li, Zhenjuan AU - Li Z AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Wang, Xiangdong AU - Wang X AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. FAU - Tang, Ping AU - Tang P AD - Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28. Haidian District, Beijing, People's Republic of China. LA - eng SI - ChiCTR/ChiCTR-TRC-14004759 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20180116 PL - Germany TA - Surg Endosc JT - Surgical endoscopy JID - 8806653 SB - IM EIN - Surg Endosc. 2018 Mar 23;:. PMID: 29572628 MH - Adult MH - Aged MH - Endoscopic Mucosal Resection/*methods MH - Esophageal Mucosa/*surgery MH - Esophageal Neoplasms/*surgery MH - Female MH - Humans MH - Male MH - Middle Aged MH - Operative Time MH - Retrospective Studies MH - Thoracic Surgery, Video-Assisted/*methods MH - Thoracoscopy/*methods OTO - NOTNLM OT - Muscularis propria OT - Submucosal tumor OT - Submucosal tunneling endoscopic resection OT - Video-assisted thoracoscopic surgery EDAT- 2018/01/18 06:00 MHDA- 2019/11/02 06:00 CRDT- 2018/01/18 06:00 PHST- 2017/09/11 00:00 [received] PHST- 2018/01/11 00:00 [accepted] PHST- 2018/01/18 06:00 [pubmed] PHST- 2019/11/02 06:00 [medline] PHST- 2018/01/18 06:00 [entrez] AID - 10.1007/s00464-018-6057-8 [pii] AID - 10.1007/s00464-018-6057-8 [doi] PST - ppublish SO - Surg Endosc. 2018 Jul;32(7):3364-3372. doi: 10.1007/s00464-018-6057-8. Epub 2018 Jan 16.