Exposed endoscopic full-thickness resection vs thoracoscopic surgery for complex esophageal subepithelial lesions arising from the muscularis propria

Table 1 Baseline clinicopathologic characteristics of enrolled patients, mean ± SD/n (%)

Variables	EFTR (n = 15)	TS (n = 45)	P value
Age, years	47.2 ± 15.6	41.6 ± 11.3	0.148
Male sex	8 (57.1)	28 (62.2)	0.734
Location			0.775
Cervical	7 (46.6)	18 (40.0)
Thoracic	4 (26.7)	17 (37.8)
Abdominal	4 (26.7)	10 (22.2)
Lesion size, mm	59.3 ± 21.7	48.7 ± 19.3	0.087
Pathology			0.041
Leiomyoma	10 (66.7)	40 (88.9)
GIST	3 (20.0)	1 (2.2)
Schwannomas	0	4 (8.9)
Others1	2 (13.3)	0 (0.0)
ASA class			0.325
I	12 (80.0)	40 (88.9)
II	3 (20.0)	5 (11.1)
III	0	0

¹Hemangioma, granuloblastoma.

EFTR: Endoscopic full-thickness resection; TS: Thoracoscopic surgery; ASA: American Society of Anesthesiologists; GIST: Gastrointestinal stromal tumor.

Table 2 Perioperative data of the endoscopic full-thickness resection and thoracoscopic surgery groups, median (range)/n (%)/mean ± SD

Variables	EFTR (n = 15)	TS (n = 45)	P value
Primary outcomes
Curative resection	15 (100)	45 (100)	> 0.999
En bloc resection	13 (86.7)	34 (75.6)	0.423
Cervical	71.4 (5/7)	77.8 (14/18)	0.739
Thoracic	100 (4/4)	88.2 (15/17)	0.471
Abdominal	100 (4/4)	50 (5/10)	0.118
Recurrence-free survival	15 (100)	43 (95.6)	0.422
Technical success	15 (100)	44 (97.8)	0.574
Clinical success	15 (100)	45 (100)	> 0.999
Secondary outcomes
Procedure time, minutes	240.0 (172.3, 262.5)	120.0 (87.50, 145.0)	< 0.001
Hospital stay, days	18.1 ± 7.4	18.78 ± 7.4	0.757
Postoperative hospital stay, days	12.2 ± 4.9	11.1 ± 5.2	0.474
Duration of antibiotic use after surgery, days	8.9 ± 5.3	8.9 ± 5.0	0.967
Nasogastric decompression tube placement	12 (80.0)	43 (95.6)	0.059
Nasogastric decompression duration, days	5.6 ± 4.9	10.7 ± 13.2	0.016
Postoperative fasting time, days	7.36 ± 3.8	10.2 ± 13.2	0.430
Hospitalization expenses, yuan	55608.1 (43969.7, 65099.5)	48680.6 (43429.0, 56037.4)	0.291
Intraoperative adverse events			0.591
Bleeding	0	2 (4.4)
Perforation	0	1 (2.2)
Postoperative adverse events			0.234
Stricture	2 (12.5)	1 (2.2)
Fistula	1 (6.3)	1 (2.2)
Chylothorax	0	2 (4.4)
Follow-up, months	36.9 ± 19.9	58.9 ± 25.1	0.004

EFTR: Endoscopic full-thickness resection; TS: Thoracoscopic surgery.

Table 3 Clinical features and outcomes of patients with postoperative adverse events

Case No.	Sex/age (years)	Adverse events	Method	Location	Size (mm)	Procedure time (minutes)	Hospital stay (days)	Use of antibiotic	Treatment
1	Female/51	Stricture	EFTR	Thoracic	85	333	21	Yes	Balloon dilation
2	Male/55	Stricture	EFTR	Abdominal	50	250	18	Yes	Stent placement
3	Male/44	Fistula	EFTR	Abdominal	57	140	40	Yes	Conservative
4	Male/22	Fistula	TS	Abdominal	60	278	19	Yes	Conservative
5	Male/67	Stricture	TS	Abdominal	75	170	20	Yes	Stent placement
6	Male/16	Chylothorax	TS	Cervical	25	156	23	Yes	Thoracic duct ligation
7	Female/72	Chylothorax	TS	Thoracic	130	226	40	Yes	Thoracic duct ligation

EFTR: Endoscopic full-thickness resection; TS: Thoracoscopic surgery.