Song Byeong Geun, Kim Ga Hee, Cho Charles J, Kim Hyeong Ryul, Min Yang Won, Lee Hyuk, Min Byung-Hoon, Song Ho June, Kim Yong-Hee, Lee Jun Haeng, Jung Hwoon-Yong, Zo Jae Ill, Shim Young Mog
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Dig Surg. 2021;38(3):247-254. doi: 10.1159/000515717. Epub 2021 Apr 28.
After noncurative endoscopic submucosal dissection (ESD) of superficial esophageal squamous cell carcinoma (SESCC), additional esophagectomy is generally recommended. However, considering its high mortality and morbidity, it is uncertain if additional surgery improves the clinical outcomes. This study aimed to compare the clinical outcomes between patients who were observed without additional treatment and those who underwent radical esophagectomy.
A total of 52 patients with SESCC who underwent complete but noncurative ESD from January 2008 to December 2016 at the Samsung Medical Center and Asan Medical Center in Korea were retrospectively analyzed. Clinicopathologic characteristics and oncologic outcomes were compared between the observation group (n = 23) and the additional surgery group (n = 29).
During a mean follow-up of 34.4 and 41.7 months, respectively, the rates of death (observation vs. surgery, 17.4 vs. 10.3%; p = 0.686), recurrence (observation vs. surgery, 13 vs. 17.2%; p = 1.000), and disease-specific death (observation vs. surgery, 4.3 vs. 6.9%; p = 1.000) did not significantly differ between the 2 groups. The 3-year overall survival was 86.3 and 96.4%, respectively (p = 0.776). The 3-year recurrence-free survival (observation vs. surgery, 85.0 vs. 88.7%; p = 0.960) and disease-specific survival (observation vs. surgery, 95.2 vs. 96.4%; p = 0.564) also did not significantly differ.
The clinical outcomes of close observation of noncuratively resected SESCC are comparable to those of additional surgery, at least in the midterm. The wait-and-see strategy could be a feasible management option after noncurative ESD of SESCC in selected patients.
对于浅表性食管鳞状细胞癌（SESCC）进行非根治性内镜黏膜下剥离术（ESD）后，通常建议进行额外的食管切除术。然而，考虑到其高死亡率和发病率，额外手术是否能改善临床结局尚不确定。本研究旨在比较未接受额外治疗而接受观察的患者与接受根治性食管切除术的患者之间的临床结局。
回顾性分析了2008年1月至2016年12月在韩国三星医疗中心和峨山医疗中心接受完整但非根治性ESD的52例SESCC患者。比较了观察组（n = 23）和额外手术组（n = 29）的临床病理特征和肿瘤学结局。
在平均分别为34.4个月和41.7个月的随访期间，两组之间的死亡率（观察组 vs. 手术组，17.4% vs. 10.3%；p = 0.686）、复发率（观察组 vs. 手术组，13% vs. 17.2%；p = 1.000）和疾病特异性死亡率（观察组 vs. 手术组，4.3% vs. 6.9%；p = 1.000）无显著差异。3年总生存率分别为86.3%和96.4%（p = 0.776）。3年无复发生存率（观察组 vs. 手术组，85.0% vs. 88.7%；p = 0.960）和疾病特异性生存率（观察组 vs. 手术组，95.2% vs. 96.4%；p = 0.564）也无显著差异。
至少在中期，对非根治性切除的SESCC进行密切观察的临床结局与额外手术的结局相当。对于部分患者，在SESCC非根治性ESD后，观望策略可能是一种可行的管理选择。
