{"title":"内镜下切除直径大于30mm的心脏粘膜下肿瘤的可行性和安全性。","authors":"Shao-Bin Luo, Zu-Qiang Liu, Li Wang, Yi-Qun Zhang, Ming-Yan Cai, Quan-Lin Li, Ping-Hong Zhou","doi":"10.1007/s00464-025-12189-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic resection has emerged as a viable option for cardial submucosal tumors (SMTs), but existing evidence remains limited by small sample sizes. This study aimed to evaluate the efficacy and safety of endoscopic resection techniques for cardial SMTs more than 30 mm in diameter.</p><p><strong>Methods: </strong>Between January 2012 and October 2024, 107 patients with cardial SMTs larger than 30 mm were included in this study. Data on patient characteristics, clinical outcomes, and follow-up were retrospectively analyzed.</p><p><strong>Results: </strong>Among 107 patients, 42 patients underwent submucosal tunneling endoscopic resection (STER), 34 patients underwent endoscopic full-thickness resection (EFTR), and 31 patients received endoscopic submucosal dissection (ESD). The mean lesion size was 4.2 ± 1.9 cm. The rate of en bloc resection and complete resection were 94.3% and 91.6%, respectively. Postoperative adverse events included delayed bleeding (2 cases), delayed perforation (2 cases), subcutaneous emphysema (2 cases) and pleural effusion (2 cases). One case of recurrence was detected during the mean follow-up period of 37.4 ± 22.5 months. Multivariate analysis showed irregular morphology (OR 2.076, 95% CI 0.513-6.274, P = 0.039) and invasion into the muscularis propria layer (OR 6.157, 95% CI1.160-7.602, P = 0.031) were independent risk factors for incomplete resection; lesion size ≥ 40 mm (OR 6.271, 95% CI 1.024-7.856, P = 0.027), irregular morphology (OR 4.734, 95% CI 1.489-6.052, P = 0.042), trans-cardia tumor (OR 5.526, 95% CI 1.160-7.602, P = 0.043) and invasion into the muscularis propria layer (OR 5.104, 95% CI 1.893-7.965, P = 0.030) were independent risk factors for long operative times.</p><p><strong>Conclusion: </strong>Endoscopic resection is an effective and safe treatment for cardial SMTs larger than 30 mm, particularly when performed by experienced endoscopists. Long-term surveillance remains crucial for early detection of recurrence.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Feasibility and safety of endoscopic resection for cardial submucosal tumors more than 30 mm in diameter.\",\"authors\":\"Shao-Bin Luo, Zu-Qiang Liu, Li Wang, Yi-Qun Zhang, Ming-Yan Cai, Quan-Lin Li, Ping-Hong Zhou\",\"doi\":\"10.1007/s00464-025-12189-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Endoscopic resection has emerged as a viable option for cardial submucosal tumors (SMTs), but existing evidence remains limited by small sample sizes. This study aimed to evaluate the efficacy and safety of endoscopic resection techniques for cardial SMTs more than 30 mm in diameter.</p><p><strong>Methods: </strong>Between January 2012 and October 2024, 107 patients with cardial SMTs larger than 30 mm were included in this study. Data on patient characteristics, clinical outcomes, and follow-up were retrospectively analyzed.</p><p><strong>Results: </strong>Among 107 patients, 42 patients underwent submucosal tunneling endoscopic resection (STER), 34 patients underwent endoscopic full-thickness resection (EFTR), and 31 patients received endoscopic submucosal dissection (ESD). The mean lesion size was 4.2 ± 1.9 cm. The rate of en bloc resection and complete resection were 94.3% and 91.6%, respectively. Postoperative adverse events included delayed bleeding (2 cases), delayed perforation (2 cases), subcutaneous emphysema (2 cases) and pleural effusion (2 cases). One case of recurrence was detected during the mean follow-up period of 37.4 ± 22.5 months. Multivariate analysis showed irregular morphology (OR 2.076, 95% CI 0.513-6.274, P = 0.039) and invasion into the muscularis propria layer (OR 6.157, 95% CI1.160-7.602, P = 0.031) were independent risk factors for incomplete resection; lesion size ≥ 40 mm (OR 6.271, 95% CI 1.024-7.856, P = 0.027), irregular morphology (OR 4.734, 95% CI 1.489-6.052, P = 0.042), trans-cardia tumor (OR 5.526, 95% CI 1.160-7.602, P = 0.043) and invasion into the muscularis propria layer (OR 5.104, 95% CI 1.893-7.965, P = 0.030) were independent risk factors for long operative times.</p><p><strong>Conclusion: </strong>Endoscopic resection is an effective and safe treatment for cardial SMTs larger than 30 mm, particularly when performed by experienced endoscopists. Long-term surveillance remains crucial for early detection of recurrence.</p>\",\"PeriodicalId\":22174,\"journal\":{\"name\":\"Surgical Endoscopy And Other Interventional Techniques\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Endoscopy And Other Interventional Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00464-025-12189-z\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Endoscopy And Other Interventional Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00464-025-12189-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：内镜切除已成为心脏粘膜下肿瘤（SMTs）的可行选择，但现有证据仍然受到小样本量的限制。本研究旨在评估内窥镜切除技术治疗直径大于30mm的心脏smt的有效性和安全性。方法：2012年1月至2024年10月，共纳入107例大于30 mm的心脏smt患者。回顾性分析患者特征、临床结果和随访数据。结果：107例患者中，42例患者行粘膜下隧道内镜切除（STER）， 34例患者行内镜全层切除（EFTR）， 31例患者行内镜粘膜下剥离（ESD）。平均病灶大小为4.2±1.9 cm。整体切除和完全切除率分别为94.3%和91.6%。术后不良事件包括迟发性出血（2例）、迟发性穿孔（2例）、皮下肺气肿（2例）、胸腔积液（2例）。平均随访37.4±22.5个月，复发1例。多因素分析显示形态不规则（OR 2.076, 95% CI 0.513 ~ 6.274, P = 0.039）和侵犯固有肌层（OR 6.157, 95% CI1.160 ~ 7.602, P = 0.031）是不完全切除的独立危险因素；病变大小≥40 mm （OR 6.271, 95% CI 1.024 ~ 7.856, P = 0.027）、形态不规则（OR 4.734, 95% CI 1.489 ~ 6.052, P = 0.042）、经贲门肿瘤（OR 5.526, 95% CI 1.160 ~ 7.602, P = 0.043）、侵犯固有肌层（OR 5.104, 95% CI 1.893 ~ 7.965, P = 0.030）是长时间手术的独立危险因素。结论：对于大于30mm的心脏smt，内镜切除是一种有效且安全的治疗方法，特别是由经验丰富的内镜医师进行手术时。长期监测对于早期发现复发仍然至关重要。
Feasibility and safety of endoscopic resection for cardial submucosal tumors more than 30 mm in diameter.
Background and aims: Endoscopic resection has emerged as a viable option for cardial submucosal tumors (SMTs), but existing evidence remains limited by small sample sizes. This study aimed to evaluate the efficacy and safety of endoscopic resection techniques for cardial SMTs more than 30 mm in diameter.
Methods: Between January 2012 and October 2024, 107 patients with cardial SMTs larger than 30 mm were included in this study. Data on patient characteristics, clinical outcomes, and follow-up were retrospectively analyzed.
Results: Among 107 patients, 42 patients underwent submucosal tunneling endoscopic resection (STER), 34 patients underwent endoscopic full-thickness resection (EFTR), and 31 patients received endoscopic submucosal dissection (ESD). The mean lesion size was 4.2 ± 1.9 cm. The rate of en bloc resection and complete resection were 94.3% and 91.6%, respectively. Postoperative adverse events included delayed bleeding (2 cases), delayed perforation (2 cases), subcutaneous emphysema (2 cases) and pleural effusion (2 cases). One case of recurrence was detected during the mean follow-up period of 37.4 ± 22.5 months. Multivariate analysis showed irregular morphology (OR 2.076, 95% CI 0.513-6.274, P = 0.039) and invasion into the muscularis propria layer (OR 6.157, 95% CI1.160-7.602, P = 0.031) were independent risk factors for incomplete resection; lesion size ≥ 40 mm (OR 6.271, 95% CI 1.024-7.856, P = 0.027), irregular morphology (OR 4.734, 95% CI 1.489-6.052, P = 0.042), trans-cardia tumor (OR 5.526, 95% CI 1.160-7.602, P = 0.043) and invasion into the muscularis propria layer (OR 5.104, 95% CI 1.893-7.965, P = 0.030) were independent risk factors for long operative times.
Conclusion: Endoscopic resection is an effective and safe treatment for cardial SMTs larger than 30 mm, particularly when performed by experienced endoscopists. Long-term surveillance remains crucial for early detection of recurrence.
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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