Abstract
OBJECTIVE: To explore the efficacy and safety of endoscopic submucosal dissection (ESD) in patients with early gastrointestinal (GI) cancer and precancerous lesion. METHODS: A total of 132 patients with early GI cancer or precancerous lesion who underwent surgery at Zunhua People's Hospital between March 2021 and June 2023 were retrospectively analyzed. Among them, 65 patients underwent endoscopic mucosal resection (EMR) (Control group), and 67 underwent ESD (ESD group). Perioperative information, treatment outcomes, stress response indicators, miR-146a and miR-199a levels, and incidence of postoperative complications were compared between the two groups. RESULTS: Surgery duration in the ESD group was significantly longer than that in the Control group. However, the intraoperative blood loss in the ESD group was lower, and the duration of anal ventilation and hospitalization was longer than in the Control group (P<0.05). Total treatment efficacy of the ESD group was significantly higher compared to the Control group (P<0.05). After the surgery, levels of serum cortisol (Cor), norepinephrine (NE), epinephrine (E), and aldosterone (ALD) in both groups significantly increased compared to those before the surgery, and were significantly lower in the ESD group compared to the Control group (P<0.05). After the surgery, expression levels of miR-146a in both groups significantly decreased, while miR-199a levels significantly increased compared to the preoperative levels, and the difference in the ESD group was more significant than in the Control group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups (P>0.05). CONCLUSIONS: In patients with early GI cancer or precancerous lesion, ESD can reduce surgical trauma, improve the expression of miR-146a and miR-199a, and alleviate the degree of surgical stress response. ESD is safe and is associated with improved treatment effectiveness and reduce occurrence of complications.