内镜黏膜下剥离术治疗浅表性近段食管肿瘤效果显著。
Endoscopic Submucosal Dissection for Superficial Proximal Esophageal Neoplasia is Highly Successful.
机构信息
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
Ann Surg. 2017 Dec;266(6):995-999. doi: 10.1097/SLA.0000000000002012.
OBJECTIVE
The aim of this study was to evaluate the outcomes of endoscopic submucosal dissection (ESD) for superficial proximal esophageal neoplasia.
SUMMARY OF BACKGROUND DATA
The surgery for a tumor located in proximal esophagus is relatively difficult and leads to a high morbidity and mortality. ESD is a minimally invasive endoscopic treatment of superficial neoplasia of the gastrointestinal tract allowing en block resection with low recurrence rates; however, ESD for superficial proximal esophageal neoplasia is little known.
METHODS
We retrospectively analyzed 102 consecutive patients who fit the inclusion criteria with 106 lesions who underwent ESD from February 2009 to July 2015 at the Zhongshan Hospital, Fudan University in Shanghai, China. During the study, the en bloc and pathologically complete resection rates, complication rate, incidence of esophageal stricture after ESD, disease-specific, and overall survival rates were evaluated.
RESULTS
The mean age was 62 (45-84) years with 100% en bloc resection rate. The mean operation time was 48 (10-144) minutes. The mean diameter of the resected tumors was 2.9 (1.2-6.5) cm. The pathological diagnoses were high-grade intraepithelial dysplasia in 45 (42.5%) lesions, and the rest were squamous cell carcinoma with staging of intraepithelial in 18 (17.0%), lamina propria in 13 (12.3%), muscularis mucosa in 16 (15.1%), SM1 in 10 (9.4%), and SM2 or deeper in 4 (3.8%) of the lesions. The R0 resection rates were 94.3% (100/106). There was no delayed bleeding. Two small perforations observed were closed successfully with clips. Symptomatic esophageal strictures in 17 (16.7%) patients were treated by endoscopic balloon dilation with a mean of 4 (1-14) times and 88.2% (15/17) success. Additional treatments of esophagectomy or chemoradiotherapy were recommended to patients with SM1 or deeper neoplasia or incomplete resection. Local recurrence was observed in 3 (2.9%) cases. Fifteen patients were lost to follow-up. Five-year overall survival rate was 98% and disease-specific survival rate was 100%. The mean follow-up time was 33.6 months.
CONCLUSIONS
ESD for the superficial proximal esophageal neoplasia is a safe and a very effective treatment method with a 100% 5-year disease-specific survival rate.
目的
本研究旨在评估内镜黏膜下剥离术（ESD）治疗表浅近端食管肿瘤的疗效。
背景资料总结
位于食管近端的肿瘤手术难度较大，导致较高的发病率和死亡率。ESD 是一种微创内镜治疗胃肠道浅表性肿瘤的方法，可整块切除，复发率低；然而，对于表浅近端食管肿瘤的 ESD 知之甚少。
方法
我们回顾性分析了 2009 年 2 月至 2015 年 7 月在复旦大学中山医院符合纳入标准的 102 例连续患者的 106 例病变，这些患者均接受了 ESD 治疗。在研究过程中，评估了整块切除和病理完全切除率、并发症发生率、ESD 后食管狭窄的发生率、疾病特异性生存率和总生存率。
结果
平均年龄为 62（45-84）岁，整块切除率为 100%。平均手术时间为 48（10-144）分钟。切除肿瘤的平均直径为 2.9（1.2-6.5）cm。病理诊断为高级别上皮内瘤变 45 例（42.5%），其余为鳞状细胞癌，其中上皮内 18 例（17.0%），固有层 13 例（12.3%），黏膜肌层 16 例（15.1%），SM1 层 10 例（9.4%），SM2 层或更深层 4 例（3.8%）。R0 切除率为 94.3%（100/106）。无延迟性出血。观察到 2 例小穿孔，均成功用夹闭闭合。17 例（16.7%）有症状的食管狭窄患者接受内镜球囊扩张治疗，平均扩张 4（1-14）次，成功率为 88.2%（15/17）。对 SM1 或更深层肿瘤或不完全切除的患者建议行食管切除术或放化疗。3 例（2.9%）患者观察到局部复发。15 例患者失访。5 年总生存率为 98%，疾病特异性生存率为 100%。平均随访时间为 33.6 个月。
结论
ESD 治疗表浅近端食管肿瘤是一种安全有效的治疗方法，5 年疾病特异性生存率为 100%。
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