Comparison of the efficacy and safety between endoscopic submucosal dissection and radical surgery for large colorectal laterally spreading tumors larger than 5 cm in diameter / 中南大学学报(医学版)

To compare the safety and efficacy between endoscopic submucosal dissection (ESD) and radical surgery (RS) for the treatment of large colorectal laterally spreading tumors (LST) larger than 50 mm in diameter. 
 Methods: From January 2011 to January 2016, a total of 82 patients were diagnosed as large LST without deep submucosal invasion (T1 SM2, ≥1 000 µm) in the Second Xiangya Hospital of Central South University. Among them, 52 patients were treated by ESD and the other 30 patients were treated by RS [laparoscopic-assisted colectomy (LAC)/open colectomy (OC)]. The clinic data were retrospectively analyzed and the en-bloc resection rate, en-bloc R0 resection rate, local recurrence, complication, procedure time and hospital stay were collected and analyzed.
 Results: The lesion sizes were (5.80±1.20) cm and (5.53±0.69) cm in diameter for ESD and RS groups, respectively (P>0.05). En-bloc resection rates, en-bloc R0 resection rates and recurrence rates showed no significant difference between the ESD group and RS group (P>0.05). Complication rate of the ESD group (7.69%, 4/52) was much lower than that in the RS group (33.33%, 10/30; P<0.01). The ESD group also had a shorter hospital stay and operation time than the RS group (P<0.05).
 Conclusion: ESD appears to be a safe, minimal invasive and effective strategy for treating large LST and it is obviously better than RS in the aspects of hospital stay, operation time and short-term complication.

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors / 中华消化外科杂志

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

Comparison of peroral endoscopic full-thickness myotomy and circular myotomy for severe achalasia / 中华消化外科杂志

Objective To compare the efficacy and safety of full-thickness peroral endoscopic myotomy (POEM) and circular myotomy for patients with severe achalasia.Methods The clinical data of 123 patients with severe achalasia who were admitted to the Second Xiangya Hospital of Central South University from August 2011 to May 2013 were retrospectively analyzed.Seventy patients who received full-thickness POEM were in the full-thickness myotomy group,and the other 53 patieuts who received circular myotomy were in the circular myotomy group.The clinical efficacies and incidences of complications of the 2 groups were compared.Patients in the 2 groups were followed up at the out-patient department till May 2014.The consecutive measurement data were presented by (x) ± s and analyzed using thc t test; the non-consecutive data were presented by M (range) and analyzed using the Wilcoxon rank test.Data before and after operation were compared using the repeated measure of analysis of variance.The count data were analyzed using the chi-square test.Results All the patients successfully received POEM.The operation time of the full-thickness myotomy group and the circular myotomy group were (57 ± 8)minutes and (63 ± 12)minutes,with significant difference between the 2 groups (t =3.421,P ＜0.05).The incidences of complications of the full-thickness myotomy group and the circular myotomy group were 14.3％ (10/70) and 11.3％ (6/53),with no significant difference between the 2 groups (x2=0.234,P ＞0.05).Atotal of 119 patients were followed up,with the median time of 18 months (range,12-24 months).The Eckardt scores at postoperative month 6 and 12 were 0 (range,0-3) and 0 (range,0-3) in the full-thickness myotomy group,and 0 (range,0-2) and 0 (range,0-3) in the circular myotomy group,with no significant difference between the 2 groups (Z =0.525,1.476,P ＞ 0.05).The sussess rates of the full-thickness myotomy group and the circular myotomy group were 98.6％ (69/70) and 98.1％ (52/53),with no significant difference between the 2 groups (x2=0.040,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 of the full-thickness myotomy group and the circular myotomy group were (3.2 ± 0.3) cm and (3.4 ± 0.4) cm,with no significant difference between the 2 groups (t =1.927,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 and 12 were significantly lesser than (5.9 ± 1.0) cm and (5.9 ± 1.0) cm before operation (F =780.923,493.018,P ＜ 0.05).No recurrence was detected in the 2 groups during the follow-up.Conclusion The short-term efficacy and incidence of complications of full-thickness myotomy and circular myotomy are comparable,while the operation time of patients who received full-thickness myotomy is shorter.