Clinical Outcomes Of Early Gastric/esophageal Cancer After Non-curative Endoscopic Resection

Background:Endoscopic submucosal dissection(ESD)has been widely accepted as the first choice for the treatment of the early gastrointestinal cancer,which increased the case of non-curative,clinically.However,there is no standard treatment strategy for non-curative endoscopic resection.Also,the comparing of the long-term outcomes of patients underwent additive treatment or not after non-curative ESD is few.Objective : We aimed to explore the long-term outcomes of non-curaive resection by a comparing of residual cancer cells rate,lymph node metastasis rate,recurrence rate and survival time,also,quality of life.We analyzed the clinicopathological of patients with different additional therapy after non-curative resection.Our study may heplful for the further treatment strategy of early gastric cancer and esophageal cancer after non-curative ESD.Methods:To study the Clinicopathological outcomes of 29 patients for early gastric cancer and early esophageal cancer after non-curative ESD at Lanzhou University Second Hospital,from May 2008 to August 2017.They were divided into 2 groups according to the different therapy.Group underwent additional gastrectomy(group A)and group under close surveillance without gastrectomy(group B).Tumor characteristics,survival time and quality of life were retrospectively studies.Results:A total of 29 cases(29 lesions)of non-curative ESD enrolled in the study and all of them were followed up,including 15 early gastric cancer and 14 early esophageal cancer.Among the 15 patients with early gastric cancer,10 patients were in the group B because of refusing additive therapy and were followed up for 27.8±12.7 months,including 9 patients with a positive lateral margin and 1 patient with a positive vertical margin.1 patient in group B with a lateral positive margin recurrenced after 8 months of ESD with a recurrence rate of 10%(1/10)、11.1%(1/9)in the patients with a positive lateral margin only.Then the additional surgery was performed and the specimen showed HGIN and well-differentiated adenocarcinoma with no vascular invasion or lymph node metastasis.The mean follow-up time of group A was 33.6±15.5months.The specimens showed residual tumor in 2 cases and lymph node metastasis in 1 case,with residual tumor rate of 40%(2/5)and lymph node metastatasis rate of 20%(1/5).There is norecurrence.Among the 14 patients with early esophageal cancer,13 patients,including 9 cases with a positive lateral margin only,2 cases of poor-differentiated squamous cell cancer and 2 cases ly/v(+),chose follow-up carefully instead of additive treatment and got a mean follow-up time of16.8±8.5 months.There is one patient that has a lateral positive margin only choose additional radiotherapy and was followed up for 12 months so far.All 14 patients of early esophageal cancer after non-curative resection had no recurrence or lymph node metastasis.Conclusion:ESD is effective for early gastric cancer and esophageal cancer.It’s not the only option that performing a additional surgury after non-curative endoscopic resection.We recommend patients with a lateral positive margin only to follow up regularly instead of another surgery.But it’s necessary for the patients with mucinous adenocarcinoma or signet-ring cell carcinoma to have a radical surgery.