Clinical Evaluation Of Endoscopic Submucosal Dissection For Patients With Superficial Esophageal Cancer And Precancerous Lesion:Report Of 491 Cases

Objective:To explore the characteristics,efficacy,complications,and risk factors in the treatment of superficial esophageal cancer and precancerous lesions with Endoscopic submucosal dissection,and to follow up the patients with positive margins.To provide reference for clinicians to better use ESD in the treatment of esophageal cancer and precancerous lesions,reduce and deal with positive ESD margins.Method:The endoscopic and pathological data of 491 patients with superficial esophageal cancer and precancerous lesions who received ESD treatment in 3 hospitals in Gansu region from June 2015 to June 2022 were collected.527 lesions were obtained,and their clinical characteristics,ESD therapeutic efficacy and complications were analyzed.The lesions were divided into positive and negative groups according to the nature of the incisional margin.Chi-square test and Logistic regression were used to analyze the risk factors of positive incisional margin.Patients with positive incisional margin were followed up,and survival analysis were used to explore the prognosis of patients with different incisional edge properties and additional treatment.Results : 1.The En bloc resection rate and complete resection rate of ESD treatment for superficial esophageal cancer and precancerous lesions were 92.4%(487/527)and 88.6%(467/527),and the incidence of positive incisal margin was 11.4%(60/527).The complication rate was 9.3%(42/451).2.The patient’s age ≥ 60 years old(OR = 2.802 P = 0.028),infiltration depth > SM1(OR = 40.249 P﹤0.001),resection area ≥ 2π(OR = 4.745 P = 0.049)may be the risk factors for positive margins of ESD treatment for superficial esophageal cancer and precancerous lesions.3.Survival analysis showed that there were differences in postoperative survival rate and postoperative recurrence/metastasis free rate between the precancerous lesion group and the cancer cell group(Log Rank P ﹤ 0.001 Breslow P ﹤ 0.001).There was no difference in postoperative survival rate and postoperative recurrence/metastasis free rate between the supplemental treatment group and the follow-up group(Log Rank P >0.05 Breslow P > 0.05).4.The recurrence/metastasis rates of esophageal cancer were12.5%(4/32)and 66.7%(10/15)in the two groups with precancerous lesions and cancer cells,respectively.Conclusion:1.ESD treatment of superficial esophageal cancer and precancerous lesions has good curative effect and low complication rate.2.The patient’s age ≥ 60 years old,the depth of lesion infiltration > SM1,and the area of lesion resection ≥ 2πMay be the risk factors for positive margins of ESD treatment for esophageal cancer and precancerous lesions.The risk of positive margin decreased with the extension of operation years(Increase in the number of operation cases).With the increase of the depth of lesion invasion,the risk of positive incisal margin increased.3.Patients with superficial esophageal cancer and precancerous lesions with positive ESD margins have a higher recurrence/metastasis rate,and should be followed up regularly.Patients with residual cancer cells may have a higher recurrence/metastasis rate and Postoperative survival rate than those with residual precancerous lesions,it requires closer review and even additional treatment.