Abstract
BackgroundLocal recurrence of esophageal squamous cell neoplasia (ESCN) and metachronous ESCN was associated with severe background esophageal multiple Lugol-voiding lesions (LVLs) even though the primary early ESCNs were treated with endoscopic resection (ER). The aim of this study is to explore the feasibility and effectiveness of combination treatments of ER and radiofrequency ablation (RFA) in patients with early ESCNs with synchronous multiple LVLs.MethodsA total of 329 patients with early ESCNs and synchronous multiple LVLs received ER combined with RFA from September 2010 to September 2020. Clinical and pathological features and treatment outcomes were retrospectively reviewed using medical records. Factors associated with background esophageal multiple LVLs before combined treatment were analyzed.ResultsThe proportion of complete response (CR) was 96.7% after primary RFA, while 90.3% patients achieved CR for the last endoscopic examinations regardless if inside or outside the treatment area (TA). Degeneration of background esophageal multiple LVLs occurred in 70.2% of patients. The grade of background esophageal multiple LVLs before combined treatment was closely related to gender, smoking, and drinking. The incidence of metachronous ESCNs outside the TA of ER and local recurrence in the TA of ER was 3.9% and 1.2%, respectively.ConclusionsProphylactic RFA treatment of multiple LVLs together with ER treatment of the primary ESCNs may be effective in reducing the incidence of metachronous ESCNs and local recurrence through improving the background esophageal mucosa.
Highlights
Esophageal cancer is the sixth most common cause of cancer death worldwide [1]
Patients were eligible if they met all of the following inclusion criteria: 1) aged 18–85 years; 2) high-resolution Lugol’s chromoendoscopy showing at least one unstained lesion (USL) containing high-grade intraepithelial neoplasia (HGIN) or early esophageal squamous cell carcinoma (ESCC) combined with multiple Lugol-voiding lesions (LVLs); 3) endoscopic ultrasound (EUS) with no submucosal invasion or lymphadenopathy; and 4) CT chest/abdomen (HGIN/ESCC patients) with no metastasis or lymphadenopathy [14, 15]
The grade of background esophageal multiple LVLs before combined treatment was closely related to gender, smoking, and drinking
Summary
Esophageal cancer is the sixth most common cause of cancer death worldwide [1]. In the Asian region, esophageal squamous cell carcinoma (ESCC) is the major histologic type of the disease [2]. Local recurrence of esophageal squamous cell neoplasia (ESCN) and metachronous ESCN was associated with severe background esophageal multiple Lugolvoiding lesions (LVLs) even though the primary early ESCNs were treated with endoscopic resection (ER). Compared with that of previous studies [6, 7, 15, 32], the additional RFA for multiple LVLs on the basis of ER of early ESCNs did not increase the incidence of postoperative complications This combination treatments for patients with early ESCNs and synchronous multiple LVLs can give full play to the advantages of complete resection of the primary lesions and pathological evaluation postoperatively and can leverage the advantages of RFA in the treatment of dense, scattered, and irregular multiple LVLs
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