A Meta Analysis Of Risk Factors For Recurrence Of Early Esophageal Squamous Cell Carcinoma Treated By Endoscopic Submucosal Dissection

Objectives Endoscopic submucosal dissection(ESD)has the advantage of minimally invasive and rapid recovery compared to surgery.However,there still have some cases of recurrence.This meta-analysis aims to evaluate the recurrence rate of ESCC patients who have been treat by ESD and to identify the risk factors that may affect recurrence,which can provide evidence and recommendations for clinical follow-up.Methods Until September 2018,we conducted a systematic search of multiple literature databases.We have developed a reasonable search strategy and inclusion and exclusion criteria to identify the recurrent ESCC patients who had been treat by ESD.A total of 24 articles were enrolled into this analysis.Data were extracted and quality of this articles were evaluated,then the combined recurrence rate was calculated.The group was divided by the possible risk factors of recurrence,to certain the difference between two group was statistically significant or not.The process was analyzed with Stata15 software and SPSS 25 software.Results 1.The total recurrence rate of ESCC patients who were treated by ESD was 3.1%,The local recurrence rate was 2.0%.The synchronous recurrence rate was 2.9%,The metachronous recurrence rate was 2.8%,The distant recurrence rate was 2.0%.2.Compared with the non-cure resection group,the risk ratio of recurrence in the curative resection group was 0.62,P=0.429>0.05,and the difference was not statistically significant.3.Compared with the submucosal cancer group,the risk ratio of recurrence rate in the intramucosal cancer group was 3.61,P=0.02<0.05,the difference was statistically significant.Submucosal cancer may be a risk factor for recurrence.4.Compared with other anatomical sites,the risk ratio of recurrence in the esophageal neck-upper thoracic segment was 2.39,P=0.046<0.05,and the difference was statistically significant.The lesion located in the upper esophagus may be a risk factor for recurrence.Conclusions Endoscopic submucosal dissection is a safety treatment for squamous cell carcinoma in the early stage.Submucosal cancer and the cervical-upper thoracic part of esophagus may be the risk factors of recurrence according to this meta-analysis.Therefore,we suggested that postoperative follow-up monitoring should be strengthened for the lesions with the above conditions.