Tu1198 CLINICAL ANALYSIS OF ESD FOR THE SYNCHRONOUS MULTIPLE PRIMARY EARLY CANCERS IN ESOPHAGUS AND STOMACH

Abstract

Objective: With the improvement of endoscopic diagnosis and treatment, the discovery rate of the synchronous multiple primary early cancers in esophagus and stomach is gradually increased, while the traditional surgery bringing serious damages. Endoscopic submucosa dissection (ESD) has become the first treatment option of early cancer or precancerous lesions in the digestive tract partly. This study intends to explore the feasibility, safety and effectiveness of ESD in the treatment of the synchronous multiple early gastric cancer or precancerous lesions in esophageal and stomach. From January 2008 to December 2016, data of 12 patients with early esophageal cancer and early gastric cancer treated by ESD in Endoscopy Center of Zhongshan Hospital, Fudan University were reviewed. We analyzed the patient's history, the size of esophageal and gastric lesions, pathological results, the results of complete or curative resection and so on. Among the 12 patients here described, all diagnosed with synchronous multiple primary early cancers in esophagus and stomach. There were 9 male cases. The mean age was (67 ± 10.6.) years. Mean size was (2.2 ± 1.1) cm in esophageal when 3 lesions located in the upper esophagus, 8 in the middle ， and 1 in the lower. The average size of gastric lesions was (2.1 ± 1.3) cm with 5 lesions in the antrum, 2 in the gastric angle and 5 in cardia. Lesions were removed by ESD in 10 cases at the same time and were removed by stage in 2 case. The complete resection rate was 100% (10/10). Postoperative pathological results showed that there were esophageal precancerous lesions with gastric precancerous lesions in 4 cases, esophageal precancerous lesions with early gastric cancer in 2 cases,early esophageal cancer with gastric precancerous lesions in 3 cases and early esophageal cancer with early gastric cancer in 3 case. 12 patients with 24 lesions were consistent with endoscopic indications, when curative resection rate was 100% (10/10). Postoperative esophageal stricture occurred in 2 cases, which were improved after dilation. Median follow-up time was 30 (8-115)months, when 9 patients survived and 3 patients died. However, the cause of death was not associated with treatment of this disease. Simultaneous endoscopic treatment for esophageal and gastric lesions is rarely reported. There are still many issues that need to be discussed, including whether lesions should be removed at the same time or by stage; which lesion should be removed first; if choosing removed by stage, how long the internal time should be and so on. Howere, ESD is a minimally invasive endoscopic surgery, which can be used as a method of treating synchronous multiple primary early cancers in esophagus and stomach.Tabled 1Clinical data of patients with synchronous multiple primary early cancers in esophagus and stomach treated with ESDNO.sexageesophagus locationsize(cm)pathologic diagnosisinvasionthe basal level and marginesophagus locationsize(cm)pathologic diagnosisinvasionthe basal level and marginpatient simultaneous resectionadditional treatmentcomplicationfollow time(m)prognosis1male65upper0.8low-grade intraepithelial neoplasiam1negativeantrum3high-grade intraepithelial neoplasiam1negativeyesnono84survival2male52middle2high-grade intraepithelial neoplasiam1negativeangle1.5high-grade intraepithelial neoplasiam1negativeyesnono115survival3male60middle1.5high-grade intraepithelial neoplasiam1negativeangle5high-grade intraepithelial neoplasiam1negativenonoesophageal stricture95survival4male84middle3early esophageal cancerm1negativecardia1.5early gastric cancerm2negativeyesnono39die5male78middle3high-grade intraepithelial neoplasiam1negativeantrum1.5high-grade intraepithelial neoplasiam1negativeyesnono27die6male68upper4high-grade intraepithelial neoplasiam1negativecardia1.5early gastric cancerm3negativenonoesophageal stricture30survival7female71upper1early esophageal cancersm1negativecardia1.5early gastric cancerm3negativeyesnono35survival8male84middle3high-grade intraepithelial neoplasiam1negativeantrum1early gastric cancerm3negativeyesnono30survival9female58middle1.4early esophageal cancerm3negativecardia1.5high-grade intraepithelial neoplasiam1negativeyesnono25survival10male59lower0.8early esophageal cancerm2negativeantrum0.6high-grade intraepithelial neoplasiam1negativeyesnono18survival11male57middle3early esophageal cancersm1negativecardia3high-grade intraepithelial neoplasiam1negativeyesnono10die12female68middle2.5early esophageal cancerm3negativeantrum4early gastric cancersm1negativeyesnono8survival Open table in a new tab