Department of Gastroenterology and Hepatology, Jinling Hospital, No. 305, East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
Department of Pathology, Jinling Hospital, No. 305, East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
Surg Endosc. 2019 Jul;33(7):2304-2312. doi: 10.1007/s00464-018-6524-2. Epub 2018 Oct 25.
NCCN Guidelines of esophageal cancer recommend that endoscopic therapy is considered "preferred" for patients with limited early-stage disease less than or equal to 2 cm. However, there is currently no definite evidence to support either endoscopic therapy or esophagectomy for early esophageal cancer larger than 2 cm. We aimed to explore the optimal treatment for this condition.
From January 2010 to June 2016, 116 patients with early esophageal neoplasia [high-grade dysplasia (HGD), lamina propria and muscularis mucosae (T1a) cancer, selected superficial submucosa (T1b) cancer without lymph node metastases] larger than 2 cm and treated either surgically or endoscopically were included.
Endoscopic therapy was performed in 69 patients and esophagectomy in 47 patients, respectively. The median follow-up time was 43.8 months in the endoscopic cohort and 49.4 months in the surgical cohort. The overall survival was similar between the two cohorts (97.1% vs. 91.5%, P = 0.18). Survival without readmission for treatment-related complicates was also similar. Minor and severe procedure-related complications occurred more often in the surgical cohort than in the endoscopic cohort (63.8% vs. 43.5% and 8.5% vs. 0 respectively, P < 0.05 for both). Four patients in the endoscopic cohort had to undergo additional esophagectomy and were alive during follow-up. There were no procedure-related deaths in the endoscopic cohort, whereas two deaths occurred in the surgical cohort. Recurrence occurred in nine patients in the endoscopic group (13%): six with local recurrence, one with residual neoplasia and two with metachronous neoplasia. None of them died after repeated endoscopic treatments.
Efficacy was similar between endoscopic therapy and esophagectomy in the treatment of early esophageal squamous cell neoplasia larger than 2 cm and endoscopic therapy was associated with fewer and manageable complications. We recommend endoscopic treatment should be preferred selected for early esophageal neoplasia larger than 2 cm.
NCCN 食管癌指南建议，对于局限于早期疾病且病变小于或等于 2cm 的患者，内镜治疗被认为是“首选”。然而，目前尚无明确证据支持内镜治疗或食管切除术治疗大于 2cm 的早期食管癌。我们旨在探讨这种情况下的最佳治疗方法。
从 2010 年 1 月至 2016 年 6 月，共纳入 116 例早期食管肿瘤[高级别上皮内瘤变（HGD）、固有层和黏膜肌层（T1a）癌、选择无淋巴结转移的浅层黏膜下（T1b）癌]大于 2cm 的患者，分别接受内镜治疗或手术治疗。
69 例患者接受内镜治疗，47 例患者接受手术治疗。内镜组中位随访时间为 43.8 个月，手术组为 49.4 个月。两组的总生存率相似（97.1%比 91.5%，P=0.18）。无因治疗相关并发症而再入院的生存率也相似。手术组的轻微和严重与手术相关的并发症发生率高于内镜组（63.8%比 43.5%和 8.5%比 0，均 P<0.05）。内镜组中有 4 例患者需要再次接受食管切除术，且在随访期间存活。内镜组无手术相关死亡，而手术组有 2 例死亡。内镜组有 9 例（13%）患者复发：6 例局部复发，1 例残留肿瘤，2 例同时性肿瘤。他们在接受多次内镜治疗后均未死亡。
内镜治疗与食管切除术治疗大于 2cm 的早期食管鳞状细胞癌的疗效相似，内镜治疗相关并发症较少且易于管理。我们建议对于大于 2cm 的早期食管肿瘤，应优先选择内镜治疗。
