Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Clin Transl Gastroenterol. 2020 Jul;11(7):e00193. doi: 10.14309/ctg.0000000000000193.
Endoscopic submucosal dissection (ESD) is a preferred treatment option for superficial esophageal squamous cell carcinoma (SESCC). However, only few studies compared long-term survival outcomes of ESD with surgery. This study compared the overall survival (OS), recurrence-free survival, and complication rates of ESD with those of surgery.
We reviewed patients who underwent ESD (n = 70) or surgery (n = 114) for SESCC at Seoul National University Hospital from 2011 to 2017. A propensity score-matched analysis was used to reduce selection bias. To increase the precision of our results interpretation, subgroups were analyzed according to the depth of tumor invasion.
In the matching study, the ESD group (n = 34) showed comparable survival outcomes with the surgery group (n = 34). The 5-year OS rates were 89.4% vs 87.8% for the ESD and the surgery groups, respectively; similarly, the 5-year recurrence-free survival rates were 90.9% and 91.6%, respectively. The ESD group showed a lower early major complication rate (2.9% [1 of 34] vs 23.5% [8 of 34], P < 0.001) and shorter hospital stay (median, 3.0 days vs 16.5 days, P < 0.001) than the surgery group. In the tumor in situ (Tis)-subgroup, ESD showed better OS than esophagectomy (P = 0.030). Between-group comparisons of survival outcomes in the T1a and T1b subgroups revealed no significant differences.
Long-term outcomes of ESD are comparable with surgery for patients with SESCC. For early major complications and duration of hospital stay, ESD was associated with better outcomes than radical surgery. These results support ESD as the preferred treatment option for SESCC.
内镜黏膜下剥离术（ESD）是治疗早期食管鳞状细胞癌（SESCC）的首选方法。然而，仅有少数研究比较了 ESD 与手术的长期生存结局。本研究比较了 ESD 与手术治疗 SESCC 的总生存（OS）、无复发生存和并发症发生率。
我们回顾了 2011 年至 2017 年在首尔国立大学医院接受 ESD（n = 70）或手术（n = 114）治疗的 SESCC 患者。采用倾向评分匹配分析来减少选择偏倚。为了提高我们结果解释的准确性，根据肿瘤浸润深度进行了亚组分析。
在匹配研究中，ESD 组（n = 34）与手术组（n = 34）的生存结局相当。ESD 组和手术组的 5 年 OS 率分别为 89.4%和 87.8%；同样，5 年无复发生存率分别为 90.9%和 91.6%。ESD 组的早期主要并发症发生率较低（2.9%[34 例中的 1 例] vs. 23.5%[34 例中的 8 例]，P < 0.001），住院时间较短（中位数，3.0 天 vs. 16.5 天，P < 0.001）。在原位癌（Tis）亚组中，ESD 的 OS 优于食管切除术（P = 0.030）。在 T1a 和 T1b 亚组中，生存结局的组间比较无显著差异。
ESD 的长期疗效与 SESCC 患者的手术相当。在早期主要并发症和住院时间方面，ESD 优于根治性手术。这些结果支持 ESD 作为 SESCC 的首选治疗方法。
