Abstract：
OBJECTIVE: The role of submucosal endoscopic dissection (ESD) in management of invasive esophageal cancer (EC) remains unclear. In this case series, we evaluate the clinical and technical outcomes of patients who underwent ESD with pathologically staged T1b EC.
METHODS: This retrospective study included patients who underwent ESD between December 2016 and April 2023 with pathologically staged T1b EC. Patient demographics, tumor characteristics, and ESD technical outcomes were analyzed. Patients were followed to determine disease-free survival and tumor recurrence rates.
RESULTS: Sixteen patients with a total of 17 pathologically staged T1b ECs were included in this case series with a median follow-up time of 28 months [range 3-75]. ESD had high en-bloc (100%) and R0 (82.3%) resection rates. 16/17 patients (94.1%) were discharged the same day, and there were no immediate perioperative complications. 4/17 patients (23.5%) had curative ESD resections with no tumor recurrence. Among those with non-curative resections (n = 13), 5 patients had ESD only, 6 had ESD + surgery, and 2 underwent ESD + chemoradiation. In the ESD only group, 2/5 patients (40%) had tumor recurrence. In the ESD + surgery group, one patient died from a surgical complication, and 1/5 (20%) had tumor recurrence at follow-up. There was no tumor recurrence among patients who had ESD + chemoradiation.
CONCLUSIONS: ESD is safe with high en-bloc and R0 resection rates in T1b EC. Recurrence rates are low but patients need close monitoring. Larger-scale studies are needed to determine the long-term clinical efficacy of ESD in T1b EC.
METHODS: This retrospective study included patients who underwent ESD between December 2016 and April 2023 with pathologically staged T1b EC. Patient demographics, tumor characteristics, and ESD technical outcomes were analyzed. Patients were followed to determine disease-free survival and tumor recurrence rates.
RESULTS: Sixteen patients with a total of 17 pathologically staged T1b ECs were included in this case series with a median follow-up time of 28 months [range 3-75]. ESD had high en-bloc (100%) and R0 (82.3%) resection rates. 16/17 patients (94.1%) were discharged the same day, and there were no immediate perioperative complications. 4/17 patients (23.5%) had curative ESD resections with no tumor recurrence. Among those with non-curative resections (n = 13), 5 patients had ESD only, 6 had ESD + surgery, and 2 underwent ESD + chemoradiation. In the ESD only group, 2/5 patients (40%) had tumor recurrence. In the ESD + surgery group, one patient died from a surgical complication, and 1/5 (20%) had tumor recurrence at follow-up. There was no tumor recurrence among patients who had ESD + chemoradiation.
CONCLUSIONS: ESD is safe with high en-bloc and R0 resection rates in T1b EC. Recurrence rates are low but patients need close monitoring. Larger-scale studies are needed to determine the long-term clinical efficacy of ESD in T1b EC.
摘要：
目的：内镜黏膜下剥离术（ESD）在浸润性食管癌（EC）治疗中的作用尚不清楚。在这个系列中,我们评估了在病理分期为T1bEC的情况下接受ESD的患者的临床和技术结局.
方法：这项回顾性研究包括在2016年12月至2023年4月期间接受ESD且病理分期为T1bEC的患者。患者人口统计学，肿瘤特征，并对ESD技术成果进行了分析。随访患者以确定无病生存率和肿瘤复发率。
结果：16例患者共17例病理分期的T1bECs纳入本病例系列，中位随访时间为28个月[范围3-75]。ESD具有较高的整体切除率（100％）和R0切除率（82.3％）。16/17患者（94.1%）当天出院，并且没有立即的围手术期并发症。4/17患者（23.5%）行ESD切除，无肿瘤复发。在非治愈性切除的患者中(n=13)，5例患者仅有ESD，6有ESD+手术，2例接受ESD+放化疗。在仅ESD组中，2/5患者(40%)有肿瘤复发。在ESD+手术组中，一名病人死于手术并发症,1/5(20%)随访时肿瘤复发。ESD+放化疗患者无肿瘤复发。
结论：ESD是安全的，在T1bEC中具有较高的整体切除率和R0切除率。复发率低，但患者需要密切监测。需要更大规模的研究来确定ESD在T1bEC中的长期临床疗效。
方法：这项回顾性研究包括在2016年12月至2023年4月期间接受ESD且病理分期为T1bEC的患者。患者人口统计学，肿瘤特征，并对ESD技术成果进行了分析。随访患者以确定无病生存率和肿瘤复发率。
结果：16例患者共17例病理分期的T1bECs纳入本病例系列，中位随访时间为28个月[范围3-75]。ESD具有较高的整体切除率（100％）和R0切除率（82.3％）。16/17患者（94.1%）当天出院，并且没有立即的围手术期并发症。4/17患者（23.5%）行ESD切除，无肿瘤复发。在非治愈性切除的患者中(n=13)，5例患者仅有ESD，6有ESD+手术，2例接受ESD+放化疗。在仅ESD组中，2/5患者(40%)有肿瘤复发。在ESD+手术组中，一名病人死于手术并发症,1/5(20%)随访时肿瘤复发。ESD+放化疗患者无肿瘤复发。
结论：ESD是安全的，在T1bEC中具有较高的整体切除率和R0切除率。复发率低，但患者需要密切监测。需要更大规模的研究来确定ESD在T1bEC中的长期临床疗效。
