Efficacy Analysis Of Endoscopic Submucosal Dissection In The Treatment Of Early Cardiac Cancer And High-grade Intraepithelial Neoplasia

Objective:To evaluate the effectiveness and safety of endoscopic submucosal dissection(ESD)for early cardiac cancer and high-grade intraepithelial neoplasia,and to analyze the influencing factors of curative resection so as to provide reliable evidence for clinical treatment.Methods:We performed a retrospective analysis of the patients with early cardiac cancer and high-grade intraepithelial neoplasia who received endoscopic submucosal dissection in the Digestive Endoscopy Center of Fujian Provincial Hospital from June2016 to November 2018.Their clinical manifestation,endoscopic appearance and histopathological information were collected,and the effectiveness and safety of endoscopic submucosal dissection were evaluated.According to the therapeutic effect,they were divided into curative resection group and non-curative resection group.Their age,sex,lesion location,lesion shape,lesion diameter,presence or absence of ulcers,lesion hierarchy etc.were compared,then the influencing factors of curative resection were analyzed.Results:A total of 104 patients with early cardiac cancer and high-grade intraepithelial neoplasia were included in this study.The patients included 82 men and 22 women,the ratio of males to females was 3.73:1,the age ranged from 27 to 80 years and the average was 62.97±7.38.There were 82 cases(78.8%)without ulcer and 22 cases(21.2%)with ulcer.Of all the lesions,85 cases(81.7%)were confined into mucosa and 19 cases(18.3%)invaded submucosa.The postoperative histology of the lesions included 30cases(28.8%)of high-grade intraepithelial neoplasia,53 cases(51.0%)of well differentiated adenocarcinoma,20 cases(19.2%)of moderated differentiated adenocarcinoma and 1 case(1.0%)of poorly differentiated adenocarcinoma.There were85 cases(81.7%)in curative resection group and 19 cases(18.3%)in non-curative resection group.The complete resection rates,en bloc resection rates and curative resection rates were 94.2%,85.6%and 81.7%respectively.The ESD-related complications included 7 cases(6.7%)of postoperative bleeding,2 cases(1.9%)of postoperative stenosis and 1 case(1.0%)of postoperative wound infection.There were19 cases in non-curative resection group,of which 10 cases received additional ESD or surgery,and 9 cases refused additional treatment.The median follow-up period was 16months(3-32 months),and no recurrence,metastasis or death occurred during the follow-up period,but 2 cases(1.9%)of residual tumor,1 case(1.0%)of synchronous carcinoma and 1 case(1.0%)of heterochrony carcinoma were found.The proportion of lesions with ulcer in the non-curative resection group was higher than that in the curative resection group,the difference was statistically significant(?~2=4.678,P=0.031).The proportion of lesions invading the submucosa in the non-curative resection group was higher than that in the curative resection group,the difference was statistically significant(?~2=10.907,P=0.001).Multivariate analysis demonstrated that ulceration(OR=3.400,95%CI:1.065-10.852,P=0.039)and submucosa invasion(OR=6.378,95%CI:2.011-20.235,P=0.002)were independent risk factors for non-curative resection.Conclusion:ESD is an effective and safe method for early cardiac cancer and high-grade intraepithelial neoplasia patients,and postoperative bleeding and stenosis are the main complications.Ulceration and submucosa invasion are independent risk factors for non-curative resection,full preoperative evaluation and reasonable treatment method are necessary for curative resection.Non-curative resection patients can choose ESD,additional surgical operation or close follow-up etc.after comprehensive evaluation.