Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
Gastrointest Endosc. 2022 Jul;96(1):18-27.e1. doi: 10.1016/j.gie.2022.02.043. Epub 2022 Mar 1.
Local recurrence of esophageal squamous cell carcinoma (ESCC) after endoscopic resection does not have an established treatment. The efficacy and safety of repeat endoscopic submucosal dissection (ESD) for recurrent ESCC were determined in the study.
Forty-three consecutive patients with 45 locally recurrent superficial ESCC lesions undergoing repeat ESD and 909 first ESD lesions for propensity score matching (PSM) at Zhongshan Hospital between January 2011 and January 2020 were retrospectively enrolled. After PSM (1:2), operation-related parameters were compared between repeat ESD and first ESD. In the repeat ESD group, the Kaplan-Meier method and log-rank tests were used for identification of risk factors for local recurrence after repeat ESD.
As compared with propensity score-matched first ESD, rates of complete resection (86.7% vs 97.8%, P = .02) and curative resection (86.7% vs 96.7%, P = .06) were lower and procedure duration (54.8 ± 21.7 minutes vs 46.2 ± 20.6 minutes, P = .67) and hospital stay (4.3 ± 1.8 days vs 2.9 ± 1.4 days, P = .25) were longer in the repeat ESD group. The en-bloc resection rate (93.3% vs 98.8%, P > .11) remained comparable. Adverse events including bleeding (4.4% vs 0%, P = .11), perforation (.0% vs .0%, P > .99), and stricture (6.7% vs 2.2%, P = .33) presented with no difference. The 5-year overall survival rate and recurrence-free survival rate for repeat ESD was 100% and 86.0%, respectively. Multiplicity was significantly associated with recurrence after repeat ESD (P = .01).
Repeat esophageal ESD showed favorable short- and long-term outcomes and thus provides an alternative choice for recurrent superficial ESCC.
内镜切除术后食管鳞状细胞癌（ESCC）局部复发尚无既定的治疗方法。本研究旨在确定重复内镜黏膜下剥离术（ESD）治疗复发性 ESCC 的疗效和安全性。
回顾性纳入 2011 年 1 月至 2020 年 1 月在中山医院接受重复 ESD 治疗的 43 例 45 处局部复发性浅表 ESCC 病变的连续患者，以及 909 例经倾向评分匹配（PSM）的首次 ESD 病变。PSM（1:2）后，比较重复 ESD 与首次 ESD 之间的手术相关参数。在重复 ESD 组中，采用 Kaplan-Meier 法和对数秩检验确定重复 ESD 后局部复发的危险因素。
与 PSM 后的首次 ESD 相比，重复 ESD 组的完全切除率（86.7% vs 97.8%，P=0.02）和根治性切除率（86.7% vs 96.7%，P=0.06）较低，手术时间（54.8±21.7 分钟 vs 46.2±20.6 分钟，P=0.67）和住院时间（4.3±1.8 天 vs 2.9±1.4 天，P=0.25）较长。整块切除率（93.3% vs 98.8%，P＞0.11）仍相似。包括出血（4.4% vs 0%，P=0.11）、穿孔（0.0% vs 0.0%，P＞0.99）和狭窄（6.7% vs 2.2%，P=0.33）在内的不良事件无差异。重复 ESD 的 5 年总生存率和无复发生存率分别为 100%和 86.0%。多发性与重复 ESD 后的复发显著相关（P=0.01）。
重复食管 ESD 显示出良好的短期和长期结果，因此为复发性浅表 ESCC 提供了另一种选择。
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