Comparative analysis of esophagectomy after endoscopic resection in early stage esophageal cancer
Jie Zhang, Haiquan Chen, Jiaqing Xiang, Yawei Zhang, Yangle Huang, Sufeng Chen, Shengfei Wang, Rui Wang, James Luketic
Abstract
ObjectiveThe aim of this study is to investigate the related factors indicating necessarily second esophagectomy after the treatment of endoscopic resection (ER) in early stage of esophageal cancer.
MethodsFrom June 2011 to March 2014, the data of patients with early stage esophageal cancer treated with ER were prospectively collected from the Department of Thoracic Surgery of Shanghai Cancer Hospital. Patients with or without further esophagectomy were followed up, and statistical analysis was carried out based on the factors including the depth of invasion(T grade), the depth of invasion of ER lesion(T0-1a or beyond T1a), the length of lesion(<3cm or ≥3cm), the location of tumor(upper, middle or lower), the degree of differentiation, and with or without lymph vascular invasion among patients without tumor residual after esophagectomy.
ResultsEighty-eight patients with early stage esophageal cancer indicated by preoperative examination and staging underwent ER surgery, and 22(25.0%) of them received further esophagectomy, among whom 7(31.8%) had no tumor residual according to the final pathological reports. Statistical analysis showed that the invasive depth of ER lesion (T0-1a or above T1b) was a predicting factor which could indicate whether the patient need further radical surgery or not(χ2=8.56, P=0.005), while that had no significant effect on the length of lesion, location of lesion, differentiation degree and lymphatic vessel invasion(χ2=1.89, P=0.361; χ2=3.01, P=0.165; χ2=3.85, P=0.121; χ2=1.02, P=1.000).
ConclusionsPatients with lesions at stage T0-1a and negative surgical margin based on the pathological results can probably avoid esophagectomy after ER. While those beyond T1a stage, especially those with dissatisfaction about ESD mucosal protrusion after submucous injection with Methylene blue or endoscopic mucosal resection(EMR) mucosal trap, were recommended for esophagectomy. As for early stage cardia cancer, it should be very cautious when choosing to perform ER surgery.
Key words:
Endoscopic resection; Early stage esophageal cancer; Esophagectomy
Contributor Information
Jie Zhang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Haiquan Chen
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Jiaqing Xiang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Yawei Zhang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Yangle Huang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Sufeng Chen
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Shengfei Wang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
Rui Wang
Department of Thoracic Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai 200032, China
Department of Oncology, Shanghai Medical College, Shanghai 200032, China
James Luketic
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, 15213, USA
