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Technical feasibility and oncologic safety of diagnostic endoscopic resection for superficial esophageal cancer
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2018-05-08 , DOI: 10.1016/j.gie.2018.04.2361
Masashi Takeuchi , Koichi Suda , Yasuo Hamamoto , Motohiko Kato , Shuhei Mayanagi , Kayo Yoshida , Kazumasa Fukuda , Rieko Nakamura , Norihito Wada , Hirofumi Kawakubo , Hiroya Takeuchi , Naohisa Yahagi , Yuko Kitagawa

Background and Aims

Active use of endoscopic resection (ER) for cM3-SM2 esophageal cancer may enable sufficient extent of esophageal resection and help determine the need for lymph node dissection based on histopathologic findings. However, ER preceding esophagectomy may have an adverse impact on outcomes. This study was designed to determine the technical feasibility and oncologic safety of diagnostic ER.

Methods

A single-institution retrospective cohort study was performed between July 2008 and June 2014. During this period, 135 consecutive patients with clinical T1a-M3N0M0, T1b-SM1N0M0, and T1b-SM2N0M0 primary esophageal cancer were referred to our division. Eight patients who underwent chemoradiotherapy as primary treatment were excluded because of inadequate pathologic findings. Based on oncologic and physical factors, we categorized the remaining 127 patients into 2 groups: primary esophagectomy (n = 54) and primary ER (n = 73).

Results

In all 127 patients, the 3-year overall survival (OS) and disease-free survival (DFS) rates were 95.7% and 87.6%, respectively. No adverse event requiring surgical intervention was observed after ER. Diagnostic ER had no negative impact on surgical outcomes, DFS, and OS after esophagectomy. Fourteen patients (19.2%) of those who received primary ER underwent curative resection, whereas 11 (20.4%) who had pT1a disease, no lymphovascular invasion, and no pathologic lymph node metastasis underwent primary esophagectomy.

Conclusions

Diagnostic ER for cM3-SM2 esophageal cancer with or without subsequent esophagectomy was feasible and safe, not only from a surgical perspective but also an oncologic perspective. Approximately 20% of cM3-SM2N0M0 patients can potentially avoid undergoing additional treatment including esophagectomy using diagnostic ER.



中文翻译:

内镜治疗浅表食管癌的技术可行性和肿瘤学安全性

背景和目标

对于cM3-SM2食管癌,积极使用内窥镜切除术(ER)可以使食管切除术达到足够的程度,并根据组织病理学发现有助于确定是否需要进行淋巴结清扫术。但是,在食管切除术之前的急诊室可能会对预后产生不利影响。本研究旨在确定诊断性ER的技术可行性和肿瘤学安全性。

方法

在2008年7月至2014年6月之间进行了一项单机构回顾性队列研究。在此期间,我们将135例连续的临床T1a-M3N0M0,T1b-SM1N0M0和T1b-SM2N0M0原发性食管癌患者转诊至我们的科室。由于病理结果不足,排除了接受放化疗作为主要治疗方法的八名患者。根据肿瘤和物理因素,我们将其余127例患者分为两组:原发性食管切除术(n = 54)和原发性ER(n = 73)。

结果

在所有127例患者中,3年总生存率(OS)和无病生存率(DFS)分别为95.7%和87.6%。ER后未观察到需要手术干预的不良事件。诊断性ER对食管切除术后的手术结果,DFS和OS没有负面影响。接受原发性ER的患者中有14例(占19.2%)接受了根治性切除,而患有pT1a疾病,无淋巴管浸润和无病理性淋巴结转移的11例(占20.4%)接受了原发性食管切除术。

结论

无论是从手术角度还是从肿瘤学角度,对有或无随后食管切除术的cM3-SM2食道癌进行诊断性ER都是可行且安全的。大约20%的cM3-SM2N0M0患者可以避免使用诊断性ER进行其他治疗,包括食管切除术。

更新日期:2018-05-08
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