Short- and long-term outcomes for early large esophageal carcinoma patients treated via double- and single-tunnel super minimally invasive surgery: a multicentre, retrospective cohort study

Super minimally invasive surgery (SMIS) via endoscopic submucosal tunnel dissection (ESTD) has shown promising preliminary efficacy for the treatment of large early esophageal cancer (EEC). This study reports the short- and long-term outcomes of both single- and double-tunnel ESTD for large EEC. All 90 patients with large EEC underwent ESTD at three hospitals between December 2013 and March 2024. We divided patients into two groups (single-tunnel SMIS and double-tunnel SMIS). Main outcome measurements: rates of en bloc resection, complete resection (R0 resection), curative resection, dissection speed and complications were evaluated as short-term outcomes. Overall survival, local or distant recurrence, and postoperative stricture rates were evaluated as long-term outcomes. For all patients, the en bloc and R0 resection rates were 97.8% and 67.8%, respectively. Post-ESTD bleeding and fever were detected in 8.9% and 17.8% of the procedures, respectively. Postoperative stenosis and recurrence occurred in 54 patients (60.0%) and 7 patients (9.5%), respectively. Among the 90 patients with different circumferential-extent lesions, those who received a double-tunnel ESTD procedure (n = 54) underwent dissection faster than those who received a single-tunnel ESTD procedure (n = 36, 0.25 vs. 0.19 cm2/min, P = 0.012). No statistically significant differences were observed between the two groups in terms of short-term postoperative complications, postoperative esophageal stenosis, survival or recurrence rates (P > 0.05). Multivariate regression analysis revealed that whole-circumferential lesions were an independent risk factor for technical difficulties. ESTD was effective for treating large early esophageal carcinoma. Compared with single-tunnel ESTD, double-tunnel ESTD has a faster resection speed, and there was no significant difference in short-term postoperative complications or long-term follow-up results. Therefore, double-tunnel ESTD is safe, reliable and more efficient in the treatment of large EEC.