Division of General and Gastrointestinal Surgery, Department of Surgery, Dalhousie University, Room 8-23/4 Victoria Building, QEII-HSC, VG Site, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada.
Division of General Surgery, Department of Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Canada.
Surg Endosc. 2023 Nov;37(11):8735-8741. doi: 10.1007/s00464-023-10318-0. Epub 2023 Aug 10.
Endoscopic mucosal resection (EMR) is an effective treatment for esophageal intramucosal adenocarcinoma (IMC), with similar recurrence and mortality rates versus esophagectomy in up to 5 years of follow-up. Long-term outcomes to 10 years have not been studied. This retrospective study investigates IMC eradication, recurrence, morbidity and mortality at 10 years following EMR versus esophagectomy in a single Canadian institution.
Patients with IMC treated via esophagectomy or EMR from 2006 to 2015 were included. Post-EMR endoscopic follow-up occurred every 3 months for 1 year, every 6 months for 2 years and every 12 months thereafter. Categorical variables were expressed as percentages and continuous variables as mean with standard deviation or median and interquartile range. The student's t-test and Fischer's exact test were used for comparisons. Survival analysis utilized the Kaplan-Meier estimator and log-rank test.
Twenty-four patients were included. Patient and tumor characteristics were similar between groups. Median follow-up for EMR and esophagectomy were 85.2 months [IQR 64.8] and 126 months [IQR 54] respectively. A mean of 1.3 EMR (SD 1.1) were required for eradication, which was seen in 12 patients (12/14, 86%). No EMR-related complications occurred. Disease progression was seen in two patients (2/14, 14%); local recurrence was seen in 1 patient (1/14, 7%). Esophagectomy eradicated IMC in 10 patients (10/10, 100%); recurrence was seen in 2 (2/10, 20%, metastatic). Major, early esophagectomy-related morbidity affected 3 patients (3/10, 30%), and late morbidity was documented for 9 (9/10, 90%). Esophagectomy and EMR had similar recurrence rates (p = 0.554). Esophagectomy was associated with significantly more procedure-related morbidity (p < 0.001). There was no difference in mortality (p = 0.442) or disease-free survival (p = 0.512) between treatment groups.
EMR and esophagectomy for the treatment of IMC are associated with comparable recurrence rates and disease-free survival in 10-year follow-up. EMR is associated with significantly lower procedure-associated morbidity. EMR can be used to treat T1a distal esophageal adenocarcinoma with minimal procedure-related morbidity, and acceptable oncologic outcomes in long-term follow-up.
内镜黏膜切除术（EMR）是治疗食管黏膜内腺癌（IMC）的有效方法，在长达 5 年的随访中，其复发率和死亡率与食管切除术相似。但尚未对 10 年的长期结果进行研究。本回顾性研究调查了在加拿大的一家单一机构中，EMR 与食管切除术治疗 IMC 后 10 年的 IMC 根除率、复发率、发病率和死亡率。
纳入了 2006 年至 2015 年接受食管切除术或 EMR 治疗的 IMC 患者。EMR 后每 3 个月进行内镜随访 1 年，每 6 个月随访 2 年，此后每 12 个月随访一次。分类变量用百分比表示，连续变量用平均值±标准差或中位数和四分位数范围表示。学生 t 检验和 Fischer 确切检验用于比较。生存分析采用 Kaplan-Meier 估计器和对数秩检验。
共纳入 24 例患者。两组患者的特征和肿瘤特征相似。EMR 和食管切除术的中位随访时间分别为 85.2 个月[IQR 64.8]和 126 个月[IQR 54]。平均需要进行 1.3 次 EMR（SD 1.1）才能达到根治，其中 12 例患者（12/14，86%）达到了这一目标。无 EMR 相关并发症发生。2 例患者（2/14，14%）出现疾病进展，1 例患者（1/14，7%）出现局部复发。10 例患者（10/10，100%）行食管切除术根除 IMC，2 例（2/10，20%，转移性）复发。3 例（3/10，30%）患者出现早期、严重的与手术相关的发病率，9 例（9/10，90%）患者出现晚期发病率。EMR 和食管切除术的复发率相似（p=0.554）。食管切除术与更多的与手术相关的发病率有关（p<0.001）。两组患者的死亡率（p=0.442）或无病生存率（p=0.512）无差异。
在 10 年的随访中，EMR 和食管切除术治疗 IMC 的复发率和无病生存率相当。EMR 与明显较低的手术相关发病率相关。EMR 可用于治疗 T1a 远端食管腺癌，具有最小的与手术相关的发病率，并且在长期随访中具有可接受的肿瘤学结果。
