Clinical Outcomes Of Early Gastric Cancer And Esophageal Cancer Patients After Endoscopic Submucosal Dissection

Background:Nowadays,because of the enhanced attention to health and upgraded endoscopic equipment,the detection rate of early gastric cancer and esophageal cancer in China is gradually increasing.The patients obtain a benefit from early diagnosis and early treatment,and get better survival and quality of life.Endoscopic Submucosal Dissection(ESD)has been extensively developed as a treatment of early digestive cancer.However,the curative effect of ESD and its influencing factors remain controversial.The objective of this study is to report the research results of our center,to explore the clinical outcome of ESD for early gastric cancer and esophageal cancer and to provide theoretical basis for clinical decision making.Methods:We conducted a retrospective study to evaluate the clinical effects and outcomes of ESD in the first affiliated hospital of Zhejiang University,which including 120 cases of early gastric cancer and 30 cases of early esophageal cancer.We drew survival curves with Kaplan-Meier Method,and conducted survival analysis with Cox's proportional hazards regression model.Furthermore,Chi-square test or Fisher exact probability method had been used for evaluate the relationship between surgical margin status and other clinical and pathological characteristics.Results:The study showed that complications of ESD for early gastric cancer was 9.2%,the positive rate of operative margin was 5.8%and average postoperative hospitalization time was 7,6 days.Moreover,the overall survival rate were 97.5%for 3 years and 94.1%for 5 years,and the recurrence-free survival rate were 95.2%for 3 years and 77.7%for 5 years respectively.Survival analysis showed that those factors including gender?the elderly situation,tumor differentiation degree?tumor infiltrating degree?complications did not have an effect on the overall survival rate and the recurrence-free survival rate(P>0.05).Positive operative margin was an independent factors for recurrence of the patients with early gastric cancer after ESD(HR=6.05,95%CI:1.39-26.29;P=0.016).Furthermore,positive operative margin was associated with infiltrating degree and Endoscopic Ultrsonography(EU S)significantly(OR=17.5;95%CI:3.32-92.09;OR=1.66;95%CI:1.43-1.93).On the other hand,we found that the complications of ESD for early esophageal cancer was 13.3%,the operative margin positive rate was 10.0%and average postoperative hospitalization time was 9.5 days,indicating that ESD was also an effective treatment for early esophageal cancer.Conclusion:In general,ESD was an effective and safe treatment for early gastric cancer and esophageal cancer.ESD had several advantages including minimally invasive?fewer complications and shorter hospitalization time.Positive operative margin was an independent factors for recurrence of early gastric cancer after ESD.What is more,pre-ESD EUS examination provided accurately diagnose of tumor infiltrating layer to choose proper candidates and reduce the rate of positive operative margin.