Original Articles of Gastrointestinal Endoscopy
Analysis of risk factors for non-curative resection after endoscopic submucosal dissection in early esophageal cancer and high-grade intraepithelial neoplasia
Jiajia Yang, Yini Dang, Lei Peng, Duochen Jin, Huaiming Sang, Meihong Chen, Guoxin Zhang
Published 2019-06-15
Cite as Chin J Dig, 2019, 39(6): 379-383. DOI: 10.3760/cma.j.issn.0254-1432.2019.06.007
Abstract
ObjectiveTo investigate the risk factors for non-curative resection after endoscopic submucosal dissection (ESD) for early esophageal cancer and high-grade intraepithelial neoplasia.
MethodsThe clinicopathological data of 427 cases of early esophageal cancer and high-grade intraepithelial neoplasia who underwent ESD was performed from January 2013 to December 2016 in the Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. According to the results of postoperative pathology and immunohistochemistry, 339 patients were defined as curative resection group and 88 patients were defined as non-curative resection group. Chi-square test, univariate analysis and multivariate logistic regression analysis were used for statistical analysis.
ResultsA total of 427 patients were enrolled in this study, with an average age of (63.2±7.7) years, including 96 cases of early esophageal cancer and 331 cases of high-grade intraepithelial neoplasia. The enbloc resection rate of ESD was 94.8%(405/427), 88 of them were non-curative resected, and the non-curative resection rate was 20.6%. Univariate analysis showed that early esophageal cancer (odds ratio (OR)=3.682, 95% confidence interval (CI) 2.216 to 6.118, P<0.01), submucosal infiltration (OR=10.220, 95%CI4.861 to 21.481, P<0.01), ESD indications (OR=6.005, 95%CI3.545 to 10.172, P<0.01) and lifting sign after injecting at the base of lesions (OR=2.508, 95%CI1.005 to 6.255, P=0.042) were statistically significant between non-curative resection group and curative resection group. Multivariate unconditional logistic regression analysis revealed that submucosal infiltration (OR=4.329, 95%CI1.758 to 10.661, P=0.001), not absolute indications of ESD (OR=6.484, 95%CI2.205 to 19.068, P=0.001) and negative lifting sign (OR=3.182, 95%CI1.171 to 8.651, P=0.023) were independent risk factors for non-curative resection.
ConclusionsPatients with early esophageal cancer, submucosal infiltration, not absolute indications for ESD and negative lifting signs are prone to non-curative resection. Moreover, submucosal infiltration, not absolute indications for ESD, and negative lifting signs are the independent risk factors for non-curative resection.
Key words:
Endoscopic submucosal dissection; Early esophageal cancer; Precancerous lesions; Non-curative resection
Contributor Information
Jiajia Yang
Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Yini Dang
Lei Peng
Duochen Jin
Huaiming Sang
Meihong Chen
Guoxin Zhang
