Objective To investigate the influencing factors associated with the difficulty in endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions.

Methods The retrospective case⁃control study was conducted. The clinicopathological data of 331 patients with early esophageal cancer and precancerous lesions who were admitted to Xinxiang Central Hospital from December 2011 to December 2021 were collected. There were 229 males and 102 females, aged (72.6±2.7)years. All patients underwent ESD. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi‑square test. The univariate analysis was performed using statistical methods appropriate to the data type. Multivariate analysis was conducted using the Logistic stepwise regre-ssion model.

Results (1) Surgical situations of ESD. The operation time of 331 patients was (67±8)minutes. There were 327 patients with en bloc resection, and 4 patients with piecemeal resection. Of the 331 patients, adverse events included bleeding in 1 case, pneumomediastinum in 2 cases, esophageal stenosis in 2 cases, and esophageal perforation in 3 cases. All of these adverse events were treated conservatively without surgical intervention. Of the 331 patients, the depth of tumor invasion was epithelial layer in 109 cases, lamina propria in 155 cases, muscularis mucosa in 9 cases, submucosal layer (<0.2 mm) in 12 cases, and submucosal layer (≥0.2 mm) in 42 cases. Of the 331 pati-ents, there were squamous cell carcinoma in 302 cases and adenocarcinoma in 29 cases. Of the 331 pati-ents, 57 cases had difficulties in ESD. (2)Analysis of Influencing factors associated with difficulty in ESD for early esophageal cancer and precancerous lesions. Results of multivariate analysis showed that esophageal cancer located in the left wall, longitudinal tumor diameter>30 mm, and tumor circumference exceeding half of the esophageal circumference were independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions (odds ratio=3.903, 6.699, 5.387, 95% confidence interval as 1.423-10.702, 1.222-36.735, 1.492-19.468, P<0.05).

Conclusion Esophageal cancer located in the left wall, tumor size greater than 30 mm and tumor circumference exceeding half of the esophageal circumference are independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions.