| Background and Objective:ESD(endoscopic submucosal dissection) developed in recent 10 years can be realized for large area early cancer or precancerous curative resection.Its treatment effect and value has gradually been clinically confirmed. But for the long-term effects of ESD, the domestic reports differ and lack long-term tracking and validation of major cases. This study aims to explore the prognosis and influencing factors of early esophageal cancer and precancerous lesions by ESD.Methods:The clinical date of 177 patients (186 lesions) were collected who had been diagnosed as early esophageal cancer or precancerous lesions by preoperative biopsy from Jan.2008 to Jun.2013 by ESD in Digestive Endoscopy Center of Chinese PLA General Hospital. All the diseased area is located in the thoracic esophagus,8 in the upper thoracic,123 in the middle and 55 in the lower part of the chest. Resection of the lesion of the mean maximum diameter of 2.9 cm (1-6 cm), resection area (2.9x2.1) cm2 (1×0.8-6×5 cm2), the average operation time was 77 (20-448) min. The curative resection was 153 cases(82.26%,153/186). Intraoperative complication occurred in 4 cases (including 1 bleeding, perforation in 3 cases) which were recovered after aggressive treatment and they all entered the follow-up group.The non-curative resection was 25 cases(13.44%,25/186), in which 5 cases were treated with surgical operation,2 cases were chose to give postoperative radiotherapy and the rest were for follow-up. The 8 cases (4.30%,8/186)which were unable to evaluate, all entered the follow-up group. The prognosis and follow-up were retrospectively analyzed.Results:The curative resection was 153 cases(82.26%,153/186), complication occurred in 4 cases which were recovered by treatment and they all entered the follow-up group.The non-curative resection was 25 cases(13.44%,25/186), in which 5 cases were treated with surgical operation,2 cases were chose to give postoperative radiotherapy and the rest were for follow-up. The 8 cases (4.30%,8/186) unable to assess entered the follow-up group. A total of follow-up was 166 cases(89.25%,166/186), in which 120 cases were through outpatient follow-up endoscopy and 46 cases were through telephone follow-up. There are 20 cases were lost to follow-up. The follow-up duration ranged from 1 to 64 months (mean 30 months). The follow-up time less than 6 months was 16 cases,29 cases from 6 to 12 months,71 cases from 12 to 36 months, more than 36 months were 50 cases. Postoperative esophageal stricture was 11 cases and the recurrence of lesions was 6 cases, among them 2 cases underwent surgical operation,4 cases were treated with ESD again. From 3 to 5 years of survival rate was 100%. The scope of the tumor ring esophagus (P=0.018) is the related factor of the occurrence of complications. The esophagus is divided into difficult operation group (upper esophageal and lower section) and easy operation group (middle esophagus),and the factors including the incidence of complications, the size of the lesion, ring cycle, pathology, surgical operation time, patient gender, age were analyzed, and the difference was not significant. The pathology(OR:7.472,95%, CI:2.321-68.08, p=0.021) was the related factors that affect the recurrence of esophageal cancer by multi factor analysis.Conclusion:ESD in the treatment of early esophageal cancer and precancerous lesions has a low incidence of long-term complications, low recurrence rate, high survival rate, and the prognosis and long-term effect is favorable, and it is worth in clinical application. Among the factors the pathology is the related factor which affect the recurrence rate of esophageal cancer after ESD. |
PDF Full Text Request