Kagawa Tomo, Ishikawa Shigenao, Inaba Tomoki, Colvin Mariko, Toyosawa Junki, Aoyama Yuki, Ishida Masaya, Kuraoka Sakiko, Okamoto Kunio, Sakakihara Ichiro, Izumikawa Koichi, Yamamoto Kumiko, Takahashi Sakuma, Tanaka Shigetomi, Matsuura Mihoko, Hasui Toshimi, Wato Masaki, Ando Midori, Nakamura Satoko, Mizobuchi Koichi
Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Department of Medical Oncology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Endosc Int Open. 2018 Apr;6(4):E450-E461. doi: 10.1055/s-0044-102296. Epub 2018 Mar 29.
Salvage therapy for esophageal cancer following chemo-radiation therapy (CRT) has not been established. We aimed to evaluate endoscopic submucosal dissection (ESD) as a salvage therapy based on histopathological features of lesions.
We compared 10 lesions in eight patients with local residual, recurrent, or metachronous esophageal squamous cell carcinoma treated by ESD after CRT (CRT group) and 59 lesions treated by ESD without CRT (non-CRT group) during the same period.
The en bloc resection rate was 100 % while the complete resection rate was 80.0 % in the lesions after CRT, indicating no difference between the CRT and non-CRT groups. Pathological examination showed that fibrosis was more intense in the lamina propria mucosa, muscularis mucosa, and submucosa. The muscularis mucosa was thicker in both non-tumor and tumor sites in the CRT group compared to the non-CRT group. However, severe submucosal fibrosis was observed only in one lesion in the CRT group. The maximum diameter of the submucosal artery was significantly larger in the CRT group ( < 0.001).
Compared to the non-CRT group, the lesions in the CRT group were accompanied by fibrosis while the muscularis mucosa were thicker; however, severe fibrosis of the submucosa was rare. It is important to dissect the muscularis mucosa appropriately during ESD, which makes successful dissection of the submucosa possible. Attention should be paid to bleeding from large arteries.
化疗放疗（CRT）后食管癌的挽救治疗方法尚未确立。我们旨在根据病变的组织病理学特征评估内镜黏膜下剥离术（ESD）作为一种挽救治疗方法。
我们比较了同期8例接受CRT后行ESD治疗的局部残留、复发或异时性食管鳞状细胞癌患者的10个病变（CRT组）和59例未接受CRT而行ESD治疗的病变（非CRT组）。
CRT后病变的整块切除率为100%，完整切除率为80.0%，表明CRT组与非CRT组之间无差异。病理检查显示，固有层黏膜、黏膜肌层和黏膜下层的纤维化更严重。与非CRT组相比，CRT组非肿瘤部位和肿瘤部位的黏膜肌层均更厚。然而，CRT组仅1个病变观察到严重的黏膜下纤维化。CRT组黏膜下动脉的最大直径显著更大（<0.001）。
与非CRT组相比，CRT组的病变伴有纤维化，黏膜肌层更厚；然而，黏膜下严重纤维化很少见。ESD期间适当剥离黏膜肌层很重要，这使得成功剥离黏膜下层成为可能。应注意大动脉出血。
