Department of Digestive Endoscopy, The Fourth Affiliated Hospital of China Medical University, 110032 Shenyang, Liaoning, China.
Department of Ultrasound, The First Affiliated Hospital of China Medical University, 110001 Shenyang, Liaoning, China.
Ann Ital Chir. 2024;95(4):534-541. doi: 10.62713/aic.3416.
Esophageal cancer is a disease with high morbidity and mortality, exploring effective treatment methods is the key to the treatment of this disease. This study aims to compare the clinical efficacy and safety of multi-band mucosectomy (MBM) and endoscopic submucosal dissection (ESD) in the treatment of single early esophageal cancer (EEC) and precancerous lesions, and whether MBM can achieve better clinical effect as an effective treatment method.
The clinical data of 70 patients with EEC and precancerous lesions who were treated with MBM and ESD in the Fourth Affiliated Hospital of China Medical University from May 2021 to May 2023 and could be followed up were retrospectively analyzed. They were divided into two groups according to different treatment methods: MBM group (31 cases) and ESD group (39 cases). The general data, perioperative conditions, endoscopic treatment effect and pathological results of the two groups were compared.
The duration of endoscopic treatment in MBM group was shorter than that in ESD group [36 (2539) min vs 46 (4157) min, p < 0.05], and there was no significant difference in the intraoperative bleeding rate between the two groups (12.90% vs 7.69%, p > 0.05). There was no significant difference in the rate of intraoperative perforation between the two groups (3.23% vs 7.69%, p > 0.05), and the hospitalization time in MBM group was shorter than that in ESD group [5 (47) days vs 8 (712) days, p < 0.05]. The hospitalization cost was less [2535 (24232786) dollars vs 4485 (38585794) dollars, p < 0.05]. No postoperative bleeding occurred in both groups. There was no statistically significant difference in postoperative stenosis rate between MBM group and ESD group (3.23% vs 12.82%, p > 0.05), and no statistically significant difference in postoperative local recurrence rate (12.90% vs 5.13%, p > 0.05). There was no significant difference in the rate of additional surgery (9.68% vs 2.56%, p > 0.05). The en bloc resection rate of MBM group was lower than that of ESD group (77.42% vs 97.44%, p < 0.05), but there was no significant difference in the complete resection rate between the two groups (87.10% vs 97.44%, p > 0.05). The postoperative pathological results of MBM group showed 13 cases of low-grade intraepithelial neoplasia (LGIN), 11 cases of high-grade intraepithelial neoplasia (HGIN), and 7 cases of canceration, while the postoperative pathological results of ESD group showed 10 cases of LGIN, 14 cases of HGIN, and 15 cases of canceration, with no statistical significance (p > 0.05).
MBM and ESD are effective methods for the treatment of EEC and precancerous lesions. MBM has the advantages of short hospital stay, quick recovery and low cost. However, compared with MBM, ESD can improve the complete resection rate of the lesion, avoid the occurrence of positive incisal margin, and reduce the risk of secondary treatment and additional surgery.
食管癌是一种发病率和死亡率都很高的疾病，探索有效的治疗方法是治疗这种疾病的关键。本研究旨在比较多环黏膜切除术（MBM）和内镜黏膜下剥离术（ESD）治疗单发早期食管癌（EEC）和癌前病变的临床疗效和安全性，以及 MBM 是否可以作为一种有效的治疗方法达到更好的临床效果。
回顾性分析 2021 年 5 月至 2023 年 5 月在中国医科大学第四附属医院接受 MBM 和 ESD 治疗的 70 例 EEC 和癌前病变患者的临床资料，这些患者可以随访。根据不同的治疗方法将他们分为两组：MBM 组（31 例）和 ESD 组（39 例）。比较两组的一般资料、围手术期情况、内镜治疗效果和病理结果。
MBM 组内镜治疗时间短于 ESD 组[36（2539）min 比 46（4157）min，p<0.05]，术中出血率两组无统计学差异（12.90%比 7.69%，p>0.05）。术中穿孔率两组无统计学差异（3.23%比 7.69%，p>0.05），MBM 组住院时间短于 ESD 组[5（47）天比 8（712）天，p<0.05]。住院费用少[2535（24232786）美元比 4485（38585794）美元，p<0.05]。两组均未发生术后出血。MBM 组和 ESD 组术后狭窄率无统计学差异（3.23%比 12.82%，p>0.05），局部复发率无统计学差异（12.90%比 5.13%，p>0.05）。追加手术率无统计学差异（9.68%比 2.56%，p>0.05）。MBM 组整块切除率低于 ESD 组（77.42%比 97.44%，p<0.05），但两组完全切除率无统计学差异（87.10%比 97.44%，p>0.05）。MBM 组术后病理结果显示低级别上皮内瘤变（LGIN）13 例，高级别上皮内瘤变（HGIN）11 例，癌变 7 例，ESD 组术后病理结果显示 LGIN10 例，HGIN14 例，癌变 15 例，差异无统计学意义（p>0.05）。
MBM 和 ESD 是治疗 EEC 和癌前病变的有效方法。MBM 具有住院时间短、恢复快、费用低的优点。但与 MBM 相比，ESD 可提高病变的完全切除率，避免切缘阳性，降低二次治疗和追加手术的风险。
