3D-printed model in the guidance of tumor resection: a novel concept for resecting a large submucosal tumor in the mid-esophagus

Although most large submucosal tumors in the esophagus such as leiomyomas are benign, obstructive symptoms may develop owing to their size [1]. Endoscopic resection of large tumors in the esophagus remains difficult [2], and exophytic tumors in the mid-esophagus are the worst. The main problem is the presence of important adjacent organs such as bronchus, aorta, and spine. We report a novel concept for facilitating endoscopic resection: 3D-printed model in the guidance of tumor resection (3DM-GTR). The 3D-printed model, based on enhanced computed tomography, could clearly display the tumor anatomy and details of adjacent structures, playing a role in planning and implementing endoscopic resection.

A 47-year-old man with intermittent dysphagia for 2 months was diagnosed with a large submucosal tumor in the mid-esophagus ([Fig. 1]). Enhanced computed tomography showed that the lesion was close to the bronchus, aorta, and spine ([Fig. 2]). The 3D-printed model directly demonstrated the tumor and its adjacent organs ([Fig. 3]). Under the guidance of the model ([Video 1]), we successfully resected the tumor ([Fig. 4]), without obvious intraoperative bleeding or other injuries to adjacent organs ([Fig. 5]). The mucosal entry was closed using endoclips. The pathology confirmed the diagnosis of leiomyoma.

Fig. 1 The submucosal tumor in the mid-esophagus, as shown by endoscopy.

Fig. 2 The submucosal tumor (arrow) and its adjacent organs, as shown by computed tomography.

Fig. 3 The submucosal tumor and its adjacent organs, as shown by 3D-printed model.

Video 1 3D-printed model in the guidance of endoscopic resection of a large submucosal tumor in the mid-esophagus.

Fig. 4 The resected tumor.

Fig. 5 The exposed aorta after tumor resection (arrows).

Fasting and prophylactic antibiotics were prescribed for 2 days. Proton pump inhibitors and nutritional support were given. The mild cervical subcutaneous emphysema detected during the procedure resolved spontaneously. The patient began drinking after 3 days and was discharged on postoperative Day 5. At 3-month follow-up, the patient had not experienced discomfort and upper endoscopy confirmed healing of the mucosa.

3DM-GTR seems a good and promising method, especially for large tumors in complex locations. The simulation model can remind the endoscopist in real time about what to expect in the next step; thus, it could reduce unexpected injuries to important adjacent organs.

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^* These authors contributed equally to this work.

Publication History

Article published online:
29 January 2020

• References

• 1 Rijcken E, Kersting CM, Senninger N. et al. Esophageal resection for giant leiomyoma: report of two cases and a review of the literature. Langenbecks Arch Surg 2009; 394: 623-629
• 2 Ye L, Sharma M, Yang D. et al. Open dissection for resection of a large submucosal tumor in the esophagus. Endoscopy 2019; 51: E243-E244