Tsujii Yoshiki, Hayashi Yoshito, Uema Ryotaro, Saiki Hirotsugu, Kimura Eiji, Nakagawa Kentaro, Fukuda Hiromu, Tajiri Ayaka, Adachi Yujiro, Yoshihara Takeo, Inoue Takanori, Kato Minoru, Yoshii Shunsuke, Suzuki Motoyuki, Makino Tomoki, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan.
Esophagus. 2025 Apr;22(2):148-156. doi: 10.1007/s10388-024-01100-9. Epub 2025 Jan 24.
Endoscopic treatment for second primary malignancies after esophagectomy has been increasingly performed; however, evidence regarding the outcomes of endoscopic submucosal dissection (ESD) for superficial cancer of the remnant esophagus after esophagectomy (SCREE) is limited.
We retrospectively extracted cases of ESD for SCREE from our institutional database, which included 739 consecutive esophageal ESD procedures performed between January 2009 and September 2023. Information on prior treatment, clinical features of the lesions, and outcomes was evaluated.
Overall, 20 patients (median age: 74 years) with 27 lesions were enrolled. ESD was performed at a median of 15 months after esophagectomy. All lesions were flat, with a median tumor diameter of 12 mm. The median ESD procedure time was 70 min. En bloc resection was achieved for all 27 lesions, with one minor perforation complication. The R0 resection rate was 96% (26 of 27). Endoscopic balloon dilation (EBD) of the anastomotic site at the beginning of ESD was required in 30% (8 of 27) of the cases. Among them, EBD was significantly more frequently performed in cases after partial esophagectomy (64%, 7 of 11) than in cases after other types of surgery. The resection speed was significantly faster in lesions after total pharyngo-laryngo-esophagectomy and slower in lesions after subtotal esophagectomy, located in the upper region, and near the anastomosis.
Our study demonstrated the feasibility of ESD for SCREE although EBD or a longer procedure duration may be required depending on the pre-ESD surgical technique and location of the lesions.
食管癌切除术后第二原发性恶性肿瘤的内镜治疗已越来越普遍；然而，关于食管癌切除术后残余食管浅表癌（SCREE）的内镜黏膜下剥离术（ESD）疗效的证据有限。
我们从机构数据库中回顾性提取了SCREE的ESD病例，该数据库包括2009年1月至2023年9月期间连续进行的739例食管ESD手术。评估了既往治疗情况、病变的临床特征和治疗结果。
总体而言，纳入了20例患者（中位年龄：74岁），共27处病变。ESD在食管癌切除术后中位15个月时进行。所有病变均为扁平型，中位肿瘤直径为12mm。ESD手术的中位时间为70分钟。27处病变均实现整块切除，发生1例轻微穿孔并发症。R0切除率为96%（27例中的26例）。30%（27例中的8例）的病例在ESD开始时需要对吻合口进行内镜球囊扩张（EBD）。其中，部分食管切除术后的病例中EBD的实施频率显著高于其他类型手术后的病例（64%，11例中的7例）。全喉咽食管切除术后病变的切除速度明显更快，而食管次全切除术后位于上部区域且靠近吻合口的病变切除速度较慢。
我们的研究证明了ESD治疗SCREE的可行性，尽管根据ESD术前的手术技术和病变位置可能需要进行EBD或更长的手术时间。
