Jiang Xiao-Han, Liu Qing, Fu Min, Wang Cheng-Fan, Zou Rui-Han, Liu Li, Wang Min
Department of Digestive Endoscopy, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Gastroenterology, The Fourth Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
J Gastrointest Surg. 2024 Dec;28(12):1988-1993. doi: 10.1016/j.gassur.2024.09.012. Epub 2024 Sep 18.
Endoscopic submucosal dissection (ESD) is a preferred method for early esophageal cancer, yet its application to esophageal adenocarcinoma (EAC), especially in the Eastern population with its relative rarity, lacks sufficient literature. This study evaluated ESD's long-term outcomes for EAC, focusing on noncurative resections and diagnostic accuracy.
Between 2012 and 2022, a retrospective study included 68 patients undergoing ESD for early EAC at Jiangsu Province Hospital. Primary outcomes encompassed ESD efficacy, en bloc resection, R0 resection, curative resection rates, and follow-up. Secondary outcomes involved noncurative ESD, T1a/T1b stage comparison, and diagnostic consistency.
Postoperative staging revealed T1a (n = 53) and T1b tumors (n = 15). En bloc resection rate was 97.1%, R0 resection rate was 79.4%, and noncurative rate was 30.9%. T1a had significantly higher R0 rate and curative resection rate. Among noncurative ESDs, 33.3% underwent esophagectomy, 42.9% had surveillance endoscopies, 19.1% repeated curative ESD, and 4.7% were lost to follow-up. Average follow-up was 63.76 ± 28.47 months. Furthermore, 6 patients had recurrence, 3 had residual lesions, and 6 deaths occurred, unrelated to ESD. No significant difference in survival or recurrence rates between curative and noncurative ESD groups was observed. ESD led to a histologic diagnosis change in 70.6% of cases, all upstaged.
ESD is effective for EAC, with higher curative rates for T1a than T1b. Noncurative ESD cases may benefit from conservative approaches. Long-term follow-up underscores poor consistency between residual lesions and positive margins. ESD serves as a valuable diagnostic staging tool, particularly for T1b cases, considering the low accuracy of endoscopic ultrasound and preoperative biopsy.
内镜黏膜下剥离术（ESD）是早期食管癌的首选治疗方法，然而，其在食管腺癌（EAC）中的应用，尤其是在相对少见的东方人群中，相关文献报道不足。本研究评估了ESD治疗EAC的长期疗效，重点关注非根治性切除和诊断准确性。
2012年至2022年，一项回顾性研究纳入了江苏省人民医院68例接受ESD治疗的早期EAC患者。主要结局包括ESD疗效、整块切除、R0切除、根治性切除率及随访情况。次要结局包括非根治性ESD、T1a/T1b分期比较及诊断一致性。
术后分期显示T1a期肿瘤53例，T1b期肿瘤15例。整块切除率为97.1%，R0切除率为79.4%，非根治率为30.9%。T1a期的R0切除率和根治性切除率显著更高。在非根治性ESD病例中，33.3%接受了食管切除术，42.9%接受了内镜监测，19.1%再次进行了根治性ESD，4.7%失访。平均随访时间为63.76±28.47个月。此外，6例复发，3例有残留病变，6例死亡，均与ESD无关。根治性和非根治性ESD组的生存率和复发率无显著差异。ESD使70.6%的病例组织学诊断发生改变，均为分期上调。
ESD治疗EAC有效，T1a期的治愈率高于T1b期。非根治性ESD病例可能从保守治疗中获益。长期随访结果显示，残留病变与切缘阳性之间的一致性较差。考虑到内镜超声和术前活检的准确性较低，ESD是一种有价值的诊断分期工具，尤其对于T1b期病例。
