Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video) - 24/08/11
Reprint requests: Yoshiaki Arimura, S-1, W-16, Chuo-ku, Sapporo 060-8543, JapanRésumé |
Background |
Endoscopic submucosal dissection (ESD) was originally developed in Japan for en bloc resection of gastric neoplasms.
Objective |
To clarify whether the novel ESD procedure is feasible and gives results that justify the pursuit of integrated minimally invasive procedures aimed at curing early squamous cell carcinoma of the esophagus (SCCE).
Design |
Retrospective cohort study.
Setting |
A single-institution trial by experienced endoscopists.
Patients |
This study involved 300 consecutively enrolled patients with SCCE (Tumor, Nodes, Metastasis classification T1, N0) who underwent either EMR (n = 184) or ESD (n = 116) from March 1994 to July 2007.
Intervention |
The patients underwent endoscopic resection and then were followed by periodic endoscopy for 8 to 174 months (mean 65 months).
Main Outcome Measurements |
Resectability, cure rates, complications, disease-free survival of the two groups, and risk factors for local recurrence were explored.
Results |
En bloc resection and the local recurrence rate were significantly better in the ESD group (P = .0009 and .065, respectively). The frequency of perforation was not significantly different between the two groups (P = .68). Four independent risk factors for local recurrence were identified by the Cox regression model: EMR, deep cancer invasion, upper esophagus location, and family history of esophageal cancer. Radical cure is mostly obtained by successful endoscopic retreatment of local recurrence after previous endoscopic resection. Disease-free survival was significantly better with ESD.
Limitations |
The study's retrospective nature prevents definitive conclusions.
Conclusions |
We provide evidence that ESD gives a higher cure rate and is safer than conventional endoscopic resection when applied to early SCCE. ESD warrants prospective comparative studies with conventional endoscopic resection.
Le texte complet de cet article est disponible en PDF.Abbreviations : Cur A, Cur B, Cur C, ER, ESD, m1, m2, m3, SCCE
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 72 - N° 2
P. 255 - août 2010 Retour au numéro
Article précédent
- Esophageal stents for the palliation of malignant dysphagia and fistula recurrence after esophagectomy
- Nicoline C.M. Van Heel, Jelle Haringsma, Manon C.W. Spaander, Paul Didden, Marco J. Bruno, Ernst J. Kuipers
- Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer
- Kanwar R. Gill, Marwan S. Ghabril, Laith H. Jamil, Muhammad K. Hasan, Rebecca B. McNeil, Timothy A. Woodward, Massimo Raimondo, Brenda J. Hoffman, Robert H. Hawes, Joseph Romagnuolo, Michael B. Wallace
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?