The Efficacy Of Endoscopic Mucosal Resection And Endoscopic Submucosal Dissection In The Therapy Of Early Esophageal Cancer And Precancerous Lesions

Objective To observe the outcomes of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection(EMR)in the management of early esophageal cancer and precancerous lesions.Methods A retrospective analysis of120patients with early esophageal cancer and precancerous lesions,who underwent EMR or ESD in our hospital from January2006to January2013. We compared the lesion size, operative time, en bloc resection rate, complete resection rate, postoperative complications, local residual rate between the EMR and ESD.Results From January2006to January2013,120patients with early esophageal cancer and precancerous lesions underwent EMR or ESD. The lesion size of EMR was(0.4±10.0) cm, median2.0cm; while the lesion size of ESD was(0.8±10.0) cm, median4.0cm (P=0.036). The median operating time of EMR was24.0minutes, range from8-122minutes; while the median operating time of ESD was63.0minutes, range from27-180minutes (P<0.01). The en bloc resection rate of EMR was36.8%(35/95), and there was positive correlation with the number of resection pieces and the lesion resection size(P<0.001), and the correlation coefficient (R) was0.365; the en bloc resection rate of ESD was96%(24/25)(P<0.001), no correlation between the number of resection pieces and the lesions size (P=0.188);and it has significantly difference between those two groups (P<0.001). The en bloc resection rate for the lesions of size larger than2cm in ESD and EMR was94.4%(17/18),10.2%(5/49), respectively (P<0.001). The en bloc resection rate for the lesions of size smaller than2cm in ESD and EMR was100%(7/7),65.2%(30/46)(P=0.154).78cases of EMR and all the cases of ESD can evaluate the complete resection.The complete resection rate of EMR and ESD was89.5%(68/78),96%(24/25)(P=0.384).The complete resection rate for the lesions of size larger than2cm in ESD and EMR was94.4%(17/18),83.3%(30/36)(P=0.474). The complete resection rate for the lesions of size smaller than2cm in ESD and EMR was100%(7/7),90.5%(38/42)(P=0.915).The complete resection rate of en bloc resection and piece-meel resection was96.6%(57/59),79.5%(35/44)(P=0.014).There were4cases (4.2%)of intraoperative bleeding and2cases(2.1%) of delayed bleeding happened in EMR group; there happened3cases (12.0%)of intraoperative bleeding and1cases(4.0%) of delayed bleeding in ESD (P>0.05). There’s no significantly difference of the bleeding rate between EMR group and ESD group. There’s also no significantly difference of the perforation rate between EMR group (0%) and ESD group(8.0%)(P>0.05). Stenosis was found in3(3.2%)patients in EMR group and2patients in ESD group(8.0%)(P>0.05). The residue rate of EMR and ESD group were8.4%(8/95),0%(0/25)(P=0.293). The local recurrence rate of EMR group during the follow-up period (range3-60months) was8.4%(8/95);1patient (4%) was found local recurrence in ESD group during the follow-up time (range3-28months)(P=0.749).2patients (2.1%) were found ectopic cancer in EMR group;none was found in ESD (P=1.00).There was significantly difference of the local recurence rate between piece-meel resection group(10.9%)and en bloc resection group(1.7%)(P=0.043)Conclusion1.Compared with EMR, ESD has superiorities in lesion size range and en bloc resection.There’s no significantly difference in the risk of bleeding, perforation and esophageal stenosis.It could be a good therapeutic method.2. For the lesions of size smaller than2cm,EMR was found to be a good choice.For EMR was simple operation, less time cost,and has similar en bloc resection rate, complete resection rate with ESD.