内镜黏膜下剥离术治疗老年食管鳞状细胞癌的疗效及安全性。
Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma.
机构信息
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
出版信息
Surg Endosc. 2017 Oct;31(10):3905-3911. doi: 10.1007/s00464-017-5421-4. Epub 2017 Mar 24.
BACKGROUND
Endoscopic submucosal dissection (ESD) has been widely applied in superficial esophageal squamous cell carcinoma (SESCC) as a minimally invasive treatment, which has advantages over surgery, especially in the elderly who have high risk of surgery. This study elucidated the efficacy and safety of ESD for SESCC in the elderly.
METHODS
Between April 2007 and June 2016, a total of 176 patients with SESCC treated with ESD were analyzed. Clinical outcomes including En bloc, complete, and curative resection rates, procedure-related complication rates, and cumulative recurrence rates were compared between the elderly (n = 46, ≥70 years of age) and the non-elderly groups (n = 130, <70 years of age).
RESULTS
Between the two groups, sex, past medical history (hypertension and diabetes), body mass index, tumor characteristics (number, location, shape, maximal and circumferential size of the tumor and the resected specimen, and depth), and use of stricture prevention except for age (elderly vs non-elderly; 74.1 ± 2.78 vs. 61.1 ± 6.06 years, p < 0.001) did not differ. En bloc resection (elderly vs. non-elderly; 93.5 vs. 93.8%, p = 1.000), complete resection (elderly vs. non-elderly; 69.6 vs. 76.2%, p = 0.433), and curative resection rates (elderly vs. non-elderly; 54.3 vs. 60.0%, p = 0.602) did not differ significantly between the two groups. Procedure time and hospital stay were also similar between the two groups. Complications of ESD such as stricture (17.4 vs. 10.8%, p = 0.299) and perforation (13.0 vs. 6.2%, p = 0.083) occurred at a similar rate in the elderly and non-elderly groups. After curative ESD, cumulative recurrence rate of the elderly group (0%) did not differ significantly to that of the non-elderly group (5.1%) by the log-rank test (p = 0.307).
CONCLUSION
ESD for SESCC is effective and safe in elderly patients as in non-elderly patients.
背景
内镜黏膜下剥离术（ESD）已广泛应用于治疗早期食管鳞状细胞癌（SESCC），作为一种微创治疗方法，其优势在于手术治疗，尤其是对于手术风险较高的老年人。本研究旨在阐明 ESD 治疗老年 SESCC 的疗效和安全性。
方法
2007 年 4 月至 2016 年 6 月，对 176 例接受 ESD 治疗的 SESCC 患者进行了分析。比较了老年组（≥70 岁，n=46）和非老年组（<70 岁，n=130）的整块切除率、完全切除率、治愈性切除率、手术相关并发症发生率和累积复发率。
结果
两组患者的性别、既往病史（高血压和糖尿病）、体重指数、肿瘤特征（数量、位置、形状、肿瘤最大和周长大小以及切除标本、深度）以及除年龄外的狭窄预防措施（老年 vs 非老年；74.1±2.78 岁 vs. 61.1±6.06 岁，p<0.001）均无差异。整块切除率（老年 vs. 非老年；93.5% vs. 93.8%，p=1.000）、完全切除率（老年 vs. 非老年；69.6% vs. 76.2%，p=0.433）和治愈性切除率（老年 vs. 非老年；54.3% vs. 60.0%，p=0.602）两组间差异均无统计学意义。两组患者的手术时间和住院时间也相似。ESD 相关并发症如狭窄（17.4% vs. 10.8%，p=0.299）和穿孔（13.0% vs. 6.2%，p=0.083）的发生率在老年组和非老年组之间也相似。在根治性 ESD 后，老年组（0%）的累积复发率与非老年组（5.1%）的累积复发率差异无统计学意义（log-rank 检验，p=0.307）。
结论
ESD 治疗 SESCC 在老年患者中与非老年患者同样有效且安全。
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