Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC, USA.
Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC, USA.
Surg Endosc. 2022 Jul;36(7):5136-5143. doi: 10.1007/s00464-021-08884-2. Epub 2021 Nov 29.
With growing application of endoscopic therapy for early-stage esophageal cancer, we sought to review our experience of endoscopic mucosal resections (EMRs). The aim of our study was to understand the natural course of these patients, especially with positive margins.
A prospectively maintained database of all patients undergoing endoscopic therapies at Georgetown University Hospital for esophageal cancer was used for the analysis between 2010 and 2020.
Of 80 patients in the EMR database, 35 were performed as index cases for esophageal adenocarcinoma. Majority (74.3%) had a pre-treatment ultrasound confirming absence of regional adenopathy. There were no post-EMR bleeding or perforation events requiring re-intervention. Complete R0 resection was achieved in 22/35 (62.9%) after initial EMR. Thirteen patients had positive margins. Of these 13 patients, only 7 patients underwent repeat endoscopic resection, 2 underwent subsequent esophagectomy, 2 received definitive radiation given poor surgical candidacy, and 2 were lost to follow-up. Overall and 5-year survival of all patients undergoing EMR was 67.9 months and 85%, respectively. Subset analysis of the 13 patients with R1 resection demonstrated an overall survival of 49.2 months and 60% 5-year survival vs overall survival of 78.9 months and 93% 5-year survival for R0 resection. At a median follow-up of 60.5 months, cancer recurrence occurred in 3 patients. All of them were successfully managed with repeat EMR.
Endoscopic resections represent a safe and effective treatment for early-stage esophageal cancer. Patients with high-risk features should be counseled to undergo an esophagectomy if they are operable candidates.
随着内镜治疗早期食管癌应用的增加，我们对内镜黏膜切除术（EMR）的经验进行了回顾。本研究的目的是了解这些患者的自然病程，尤其是切缘阳性的患者。
使用 2010 年至 2020 年期间乔治敦大学医院所有接受内镜治疗的食管癌患者的前瞻性维护数据库进行分析。
在 EMR 数据库的 80 例患者中，有 35 例为食管腺癌的初始病例。大多数（74.3%）患者在治疗前进行了超声检查，以确认无区域性淋巴结转移。无 EMR 后出血或穿孔需要再次干预的事件。22/35（62.9%）例初始 EMR 后达到完全 R0 切除。13 例患者切缘阳性。这 13 例患者中，仅有 7 例行再次内镜切除术，2 例行后续食管切除术，2 例因手术条件差接受根治性放疗，2 例失访。所有接受 EMR 的患者的总生存率和 5 年生存率分别为 67.9 个月和 85%。R1 切除的 13 例患者的亚组分析显示，总生存率为 49.2 个月，5 年生存率为 60%，而 R0 切除的总生存率为 78.9 个月，5 年生存率为 93%。在中位随访 60.5 个月时，3 例患者出现癌症复发。所有患者均通过再次 EMR 成功治疗。
内镜切除术是治疗早期食管癌的一种安全有效的方法。对于有高危特征的患者，如果有手术机会，应建议其行食管切除术。
