Feasibility And Safety Of Endoscopic Submucosal Dissection In The Treatment Of Early Esophageal Cancer Near Scar After ESD Surgery

BackgroundEarly esophageal carcinoma(EEC)is carcinoma that is confined to the mucosa and submucosa of the esophagus without lymph node metastasis.Meanwhile,Endoscopic submucosal dissection(ESD)is one of the main endoscopic procedures in China,and the feasibility and safety of ESD in EEC treatment has been confirmed by a large number of clinical trials.However,synchronous or metachronous multipleesophageal cancers are still possible after ESD treatment,even in the vicinity of previous ESD scars.At present,domestic clinical studies on the feasibility and safety of re-implementation of ESD for early esophageal cancer or precancerous lesions near ESD scar are limited.ObjectiveIn order to verify the safety and feasibility of ESD treatment for early esophageal cancer or precancerous lesions near previous ESD scar.This study retrospectively analyzed the therapeutic effects and complications of early esophageal cancer or precancerous lesions occurring for the first time and esophageal cancer or precancerous lesions near ESD scar by collecting previous cases of ESD,in order to provide reference for the selection of ESD treatment for early esophageal cancer near ESD scar.MethodsPatients with early esophageal cancer or precancerous lesions who underwent ESD treatment in the Gastroenterology Department of Shandong University Qilu Hospital from January 2018 to March 2022 were selected as the study objects.1.All patients were confirmed as early esophageal cancer or precancerous lesions by pathological examination before surgery.2.It meets ESD indication.3.Patients and their families are informed and sign informed consent.Exclusion criteria:1.Under the age of 18.2.Preoperative diagnosis of lesions infiltrating into the deep submucosal layer accompanied by distant metastasis or lymph node metastasis.3.Patients receiving adjuvant therapy before surgery,such as chemoradiotherapy.4.Patients with cocoagulation dysfunction or taking anticoagulants.5.Patients with poor general conditions who cannot tolerate endoscopic surgery.In this study,patients who met the criteria were divided into two groups,the first ESD group and the ESD scar group.General population characteristics,pathological characteristics,surgical conditions,length of hospital stay,and operation-related adverse events were collected for statistical analysis.ResultsIn this study,a total of 376 patients met the natrification criteria.Among them,343 cases were in the first ESD group and 33 cases were in the ESD scar group.There were no statistical differences in demographic characteristics,complications,lesion size,lesion location,circumferential size,macroscopic manifestations,postoperative pathology,lesion depth,and vascular infiltration between the two groups.The complete resection rate in the first ESD group was higher than that in the ESD scar group(95.0%vs78.8%,P=0.001),and the curative resection rate was higher than that in the ESD scar group(92.4%vs78.8%,P=0.02).The mean operation time in the ESD scar group was longer than that in the first ESD group(P=0.01),and the length of hospital stay was not statistically different between the two groups.There were no significant differences in the incidence of bleeding,perforation,stenosis and postoperative pain between the two groups.The incidence of muscle injury was higher in the ESD scar group than in the first ESD group(28.0%vs45.5%,P=0.036).ConclusionESD is less effective than first esophageal disease in treating early esophageal cancer or precancerous lesions near ESD scar.In terms of the adverse events of ESD surgery,only the incidence of muscle layer injury was higher than that of the first esophageal disease,and there was no significant difference in bleeding,perforation,stenosis,and postoperative pain.Overall,ESD can still be used as one of the treatment options for early esophageal cancer or precancerous lesions near ESD scar.