Lu Wei, Li Peng, Wen Wu, Jian Yi
Department of Gastroenterology, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Front Surg. 2022 May 6;9:917689. doi: 10.3389/fsurg.2022.917689. eCollection 2022.
Endoscopic dissection (ED) shows relatively high clinical value in early esophageal cancer (cT1N0) such as lower incidence of postoperative complications and hospitalization costs and enhanced recovery. However, whether ED still has certain advantages over esophagectomy in terms of long-term survival remains unclear.
The aim of this meta-analysis was to compare the long-term outcomes of ED and surgery in the treatment of cT1N0 esophageal cancer.
Several electronic databases including the PubMed, EMBASE, Web of Science and Cochrane Library databases were searched up to April 7, 2022 for studies which compared the overall survival (OS) and disease-specific survival (DSS) of cT1N0 esophageal cancer patients receiving the ED or esophagectomy. The hazard ratios (HRs) and 95% confidence intervals (CIs) were combined and all statistical analysis was conducted through STATA 15.0 software.
A total of 12 studies involving 3,732 patients were enrolled. No significant difference in the OS between ED and surgery groups was observed (HR = 0.78, 95% CI, 0.59-1.04, = 0.089). However, the DSS of the ED group was significantly longer than that of the surgery group (HR = 0.56, 95% CI, 0.39-0.82, = 0.003).
In overall, the current evidence manifested that the long-term survival of cT1N0 esophageal cancer patients undergoing ED was not worse than that of patients undergoing esophagectomy. ED may be considered as the primary treatment for cT1N0 esophageal carcinoma patients.
内镜下切除术（ED）在早期食管癌（cT1N0）中显示出较高的临床价值，如术后并发症发生率和住院费用较低，恢复较快。然而，在长期生存方面，ED相对于食管切除术是否仍具有一定优势尚不清楚。
本荟萃分析的目的是比较ED和手术治疗cT1N0食管癌的长期疗效。
检索了包括PubMed、EMBASE、Web of Science和Cochrane图书馆数据库在内的多个电子数据库，检索截至2022年4月7日比较接受ED或食管切除术的cT1N0食管癌患者总生存（OS）和疾病特异性生存（DSS）的研究。合并风险比（HRs）和95%置信区间（CIs），并通过STATA 15.0软件进行所有统计分析。
共纳入12项研究，涉及3732例患者。ED组和手术组的OS无显著差异（HR = 0.78，95% CI，0.59 - 1.04，P = 0.089）。然而，ED组的DSS显著长于手术组（HR = 0.56，95% CI，0.39 - 0.82，P = 0.003）。
总体而言，目前的证据表明，接受ED的cT1N0食管癌患者的长期生存并不比接受食管切除术的患者差。ED可被视为cT1N0食管癌患者的主要治疗方法。
