Aims and Background Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma
Aims and Background Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma. eight metachronous and three distant recurrences). Eight patients died during follow-up, of which two (4%) patients died from oesophageal squamous cell carcinoma. Factors significantly associated with mortality in this series were: moderate or poor differentiation of oesophageal squamous cell carcinoma (test for quantitative variables and Chi-square test or Fishers exact assessments for qualitative variables were used in the univariate analysis. All statistical analyses were performed using the SPSS software program (version 18.0) (IBM, Armonk, New York, USA). A two-tailed (%)?Male36 (74%)?Female13 (26%)Charlson comorbidity score C mean??SD5??2History of C (%)?Cirrhosis12 (24%)?ENT cancer11 (22%)Antiplatelet therapy C (%)8 (14%)Chronic alcohol abuse C (%)20 (45%)Tobacco user C (%)22 (52%)History of thoracic radiotherapy C (%)?Low grade dysplasia2 (4%)?High grade dysplasia15 (27%)?Squamous cell carcinoma39 (69%) Open in a separate window ENT: ear, nose, and throat; ESCC: early squamous cell carcinoma; ESD: endoscopic submucosal dissection; SD: standard deviation On pretherapeutic CT scan, five (9%) patients had a thickening of the oesophagus and non-specific mediastinal lymph nodes were seen in two (4%) patients. EUS was performed in 52 (93%) cases. Lesions were classified as usT1N0 in 94% of cases and EUS findings were inconclusive in 6% of the cases. EUS found peri-oesophageal lymph nodes in one patient Rabbit Polyclonal to RhoH and us T2 stage in none of the patients. However, the lymph nodes were not found to be suspicious and ESD was carried out. Procedural data The endoscopic findings and procedural characteristics of the 56 Carboplatin ESDs are presented in Table 2. All ESD procedures were successful, however en-bloc resection failed in one lesion. Eighty percent of the patients had a Paris 0-IIa lesion, and the predominant tumour location was the center third of oesophagus (57%). Finally, 48% from the lesions had been resected with an obvious mucosal defect exceeding 75% from the oesophageal circumference. Desk 2. Endoscopic results and procedural features from the 56 endoscopic submucosal dissections (ESDs) for early squamous cell carcinoma from the esophagus. Localization from the lesion in the esophagus C (%)?Top third6 (11%)?Middle third32 (57%)?Decrease third18 (32%)Paris classification C (%)?0CIIa21 (38%)?0CIIb10 (18%)?0CIIc1 (2%)?IIaCIIb12 (21%)?IIaCIIc10 (18%)?IIbCIIc1 (2%)?0CIs1 (2%)En bloc resection C (%)55 (98%)Circumference from the mucosal defect after ESD C (%)? 50%17 (31%)?50%C75%12 (21%)?75%C 100%21 (38%)?Circumferential6 (11%) Open up in another home window Adverse events The median (IQR) amount of medical center stay was three (2.7C3) times. Early adverse occasions happened in five situations (9%), including three oesophageal perforations diagnosed during ESD and shut by haemoclips instantly, with subsequent conventional treatment, one aspiration pneumonia and one large rash related to the anaesthetic agent. No severe bleeding happened. All three perforations had been graded as moderate as well as the last two early adverse events as mild. The level of 30-day mortality was 0%. The overall stricture rate was 20%, with an overall good Carboplatin response to dilatation: seven patients experienced one dilation, two patients experienced 5 dilations, one individual experienced 5 dilations. Steroids were administered orally to one patient with circumferential ESD of the upper third of the oesophagus, who eventually developed a stricture requiring over five dilatations. No individual received local injection or application of steroids for oesophageal stricture prevention. Three factors were significantly associated with the development of a post-ESD stricture in the univariate analysis: largest lesion diameter 41?mm ((%)48 (86%)?Positive lateral margins5 (9%)?Positive vertical margins4 (7%)?Positive vertical and lateral Carboplatin margins1 (2%)Curative resection rate40 (71%) Open in a separate window R0 resection: histologically total resection; SD: standard deviation. Table 4 displays outcomes depending on depth of ESCC invasion. Factors significantly associated with deep submucosal invasion of ESCC in univariate analysis were: absence of.
