Clinical Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Neoplasms: A Retrospective Single-Center Study in China.

Yanfang Chen,Xiaojing Zhao,Ye Zhao,Ruihua Shi

doi:10.1155/2016/3741456

Abstract

Aims. To retrospectively analyze the clinical outcomes for a large number of endoscopic submucosal dissections (ESDs) in early esophageal squamous cell neoplasms (ESCNs) at the First Affiliated Hospital of Nanjing Medical University. Patients and Methods. From January 2010 to February 2014, 296 patients (mean age 61.4 years, range 31–85 years; 202 men) with 307 early ESCNs (79 intramucosal invasive esophageal squamous cell carcinomas (ESCCs) and 228 high-grade intraepithelial neoplasia (HGIN) cases) were included from a total of 519 consecutive patients who were treated by esophageal ESD at our hospital. The primary end points of the study were rates of en bloc resection and complete resection. Secondary end points were complications, residual and recurrence rates, and mortality during follow-up. Results. The en bloc resection rate and complete resection rate were 93.5% and 78.2%, respectively. Complications included strictures (8.4%), perforations (1.0%), and bleedings (0.7%). Twenty-seven (9.1%) patients experienced residual and 18 (6.1%) patients experienced recurrence during a mean follow-up period of 30 months. Thirteen patients died from causes unrelated to ESCC, and no cancer-related death was observed. Conclusions. Our study showed that ESD is a successful and relatively safe treatment for intramucosal invasive ESCC and HGIN, fulfilling the criteria of lymph node negative tumors. This should encourage clinicians to select ESD performed by experienced operators as a potential or even preferred treatment option for lesions amenable to endoscopic treatment.

Highlights

Early-stage esophageal squamous cell neoplasms (ESCNs) are increasingly recognized and detected by endoscopists, due to improvements in endoscopic image quality and increased education and awareness of these often flat lesions [1,2,3]
Endoscopic resection has been increasingly conducted around the world, which aims to maintain the integrity of the esophagus and avoid the high morbidity and mortality rates of surgical treatment [5], and has been shown to be effective
296 patients who met the following criterion were included in the present retrospective study: a histologically confirmed diagnosis of intramucosal invasive esophageal squamous cell carcinoma (ESCC) or high-grade intraepithelial neoplasia (HGIN) on the endoscopic submucosal dissections (ESDs) specimen (Figure 1)

Summary

Introduction

Early-stage esophageal squamous cell neoplasms (ESCNs) are increasingly recognized and detected by endoscopists, due to improvements in endoscopic image quality and increased education and awareness of these often flat lesions [1,2,3]. Endoscopic resection has been increasingly conducted around the world, which aims to maintain the integrity of the esophagus and avoid the high morbidity and mortality rates of surgical treatment [5], and has been shown to be effective. En bloc resection improves the histological assessment of the specimens and can reduce the risk of recurrence. ESD was initially developed in Japan, to improve endoscopic treatment of early gastric cancer [8, 9], and has been shown to be superior to conventional EMR in terms of en bloc resection rate and recurrence rate [10]. Some studies showed that ESD could have a higher

Methods

Results

Conclusion