Clinical Analysis In 78 Patients With Early Esophageal Carcinoma After Endoscopic Submucosal Dissection

Objective:Endoscopic submucosal dissection(ESD)is widely used in dealing with esophageal neoplasms with high rates for en bloc resection.This study aims to evaluate the feasibility and long-term outcomes of ESD for early esophageal carcinoma(EEC)·Patients and methods:From July 2009 to September 2015,78 patients with EEC were treated by ESD at the First Affiliated Hospital of Nanjing Medical University.En bloc,complete resection,complication,and local recurrence rates were evaluated retrospectively.Results:The en bloc resection and pathologically complete resection rates were 75.6%and 61.5%,respectively.Perforation was observed in 3(3.8%)patients.In total,15(19.2%)patients experienced post-ESD strictures.Massive bleeding did not occur in any patients.In 78 patients with EEC,recurrence was detected in 8(11.7%)patients after a mean follow-up period of 47 months.Recurrent rate in patients with positive margins was 15.4%while in patients with negative margins was 11.4%.In 9 patients who underwent surgical resection(2 cases of submucosal carcinoma,7 cases of mucosa carcinoma),lymph node metastasis was not found.In 5 patients with positive resection margins,tumor cells were not seen in surgical pathology specimens except one patient with a bit of resisal.A total of 13 patients with submucous infiltration within 200-800um,additional treatment was not carried and recurrence was not seen during follow-up period.Nine patients with poorly differentiated cancer within the mucosal muscularis,only 1 case of horizontal positive margin was carried out with additional treatment.The longest follow-up time was 69 months and no recurrence was seen.In 8 cases with recurrence,7(87.5%)of them recurred 3 in years after ESD.Another one patient showed postoperative local recurrenee after 61 months.During the observation,2 patients died of esophageal carcinoma.The rate of 5-year cause-specific survival rate was 97.1%.Conclusion:The long-term follow-up study revealed favorable clinical outcomes.ESD seems to be an safe and effective treatment for EEC.Patients with esophageal carcinoma may be diagnosed with loeal recurrent lesion so that patients should exam regularly and diagnose early.The resection leisons with tumor eells adjacent to the vertical edge should not be considered as equal to negative margin.Because some of them may even have been local lymph node metastasis.These patients need to follow-up closely and additional treatment may be carried out if necessary.For poorly differentiated carcinoma within mucosal museularis with negative resection margin,long-term follow-up without additional treatment may be acceptale.Older,poor general condition,cardiopulmonary insufficiency patients may still have the possibility of follow-up even if their resection lateral margins were positive.The necessary of additional surgery needs further study in patients with positive lateral margin.Most of recurrence occurs in the first 3 years and needs extensive attention.