Stage T1 Esophageal Endoscopic ESD Treatment And Surgical Treatment Effect Comparison And Analysis

Objective To compare the therapeutic result of endoscopic submucosal dissection and open surgical resection for early esophageal cancer.And to investigate the related factors indicating necessarily second esophagectomy after the treatment of ESD.Methods Early esophageal cancer patients confirmed by pathology treated by EMR were analyzed retrospectively in the First Affiliated Hospital of Nanjing Medical University from July 2011 to June 2015.Comparing efficacy of ESD group and surgical group,analyze their survival to assess the feasibility and safety of ESD.Retrospective analysis of the first affiliated hospital of Nanjing Medical University from July 2011 to June 2015 at the records of 215 cases of early esophageal lesions in patients of the Digestive System Department and the records of 208 cases of Thoracic Surgery postoperative pathological tips for patients with stage T1 esophageal cancer and precancerous lesions.Compare the therapeutic effect of endoscopic therapy and surgery.Results Endoscopic ESD surgery in 215 patients,a total of 227 lesions were completely stripped,stripping success rate was 100.0%.There were 203 cases of single lesion and lesions both in the middle and lower segments of 12 cases,including 21 cases in the upper segment,148 cases in the middle segment and 34 cases in the lower segment.There were 74 cases with the length of lesion more than 3.0cm,and the longest was 8cm.According to ESD postoperative pathologic results:34 cases(15.81%)had positive margins,including 0 cases(0/105)of the lesion was confined to the mucosa,14 cases(14/76)of the lesions confined to the mucosal muscle and 16 cases(16/30)of the lesion invades the submucosal layer 3 cases(3/4)of the lesion infiltrated muscle;61 cases(28.37%)patients with preoperative pathology prompted high-grade intraepithelial rheology,postoperative found that cancerous tissue,including 2 cases(2/105)of the lesion was confined to the mucosa,32cases(32/76)of the lesions confined to the mucosal muscle,24 cases(24/30)of the lesion invades the submucosal layer,3 cases(3/4)of the lesion infiltrated muscle;20 patients with thoracic surgery additional esophageal surgery,postoperative pathological results showed that 7 cases Tumor TNM stage escalation,4 cases of lymph node metastasis(2 cases of Tla stage and 2 cases of T1b).There were 208 patients in the surgical department,31 cases with the lesions in the upper segment,126 cases with the lesions in the middle and 43 cases with the lesions in the lower segment.There were 121 cases by minimally invasive surgery and 87 cases by minimally invasive surgery.All of the lesions were completely resected.Routine pathological findings showed that 39 cases had lymph node metastasis,0 cases(0/26)of the lesion was confined to the mucosa,9 cases(9/3 9)of the lesions confined to the mucosal muscle,30 cases(30/143)of the lesion invades the submucosal layer.10 cases showed intravascular tumor thrombus,0 cases(0/26)in mucosa,2 cases(2/39)of mucosal muscularis and 8 cases(8/143)of submucosal layer.Conclusion According to ESD postoperative pathologic results:TO-la period and cut edge negative patients,ESD is effective treatment,surgery can be substituted.If the postoperative displayes that the cut edge have residual,beyongd T1a stage,ESD postoperative pathologic find cancerous tissue,prompt and preoperative gastroscopy lesions-3 cm in length and tumour violate the esophagus ring more than two-thirds,cancer cells in middle and low differentiation,surgical operation is recommended.