ABSTRACT
Objective:To investigate the efficacy of additional treatment (chemoradiotherapy or esophagectomy) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma.Methods:Clinicopathological data of 97 patients of esophageal squamous cell carcinoma with infiltration depth of M3-SM3 who underwent ESD in Zhongda Hospital from July 2014 to April 2019 were reviewed. There were 57 patients in the additional treatment group and 40 patients in the observation group. The rate of relapse-free survival (RFS) was evaluated by Kaplan-Meier method (used log-rank test).Results:In the additional treatment group, 15 underwent esophagectomy after ESD, and no tumor metastases were found, but 1 patient died of upper gastrointestinal bleeding after surgery; 42 underwent chemoradiotherapy, and all patients were alive, but 3 patients experienced distant metastases. In the observation group, 13 patients experienced local recurrence, 2 patients died of tumor recurrence and 1 patient died of cerebrovascular disorder. Kaplan-Meier analysis showed that the RFS rate of the additional treatment group was higher than that of the observation group ( P=0.001). Conclusion:ESD followed by additional chemoradiotherapy or esophagectomy has good clinical efficacy and can improve prognosis for superficial esophageal squamous cell carcinoma (M3-SM3) patients.
ABSTRACT
Objective:To evaluate the efficacy and safety of oral prednisone acetate and oral prednisone acetate combined with local injection of triamcinolone acetonide for the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions.Methods:Data of 52 patients with early esophageal cancer or precancerous lesions hospitalized from December 2014 to February 2019 in Zhongda Hospital of Southeast University were analyzed retrospectively. They were divided into the control group (group A, n=20), oral hormone group (group B, n=17) and oral medication combined with local injection group (group C, n=15). The rates of stenosis and refractory stenosis, endoscopic dilatation times after ESD, time interval of first dilation after ESD and adverse events related to the operation and administration of glucocorticoids were compared among the three groups. Results:The differences in stenosis rates [85.0% (17/20) VS 47.1% (8/17) VS 46.7% (7/15), P<0.01], rates of refractory stenosis [75.0% (15/20) VS 23.5% (4/17) VS 20.0% (3/15), P<0.01], and endoscopic dilatation times [3.50 (2.25, 6.00) VS 0.00 (0.00, 2.50) VS 0.00 (0.00, 2.00), P<0.01] were statistically significant among the three groups. In pairwise comparison, the above indicators in group B and group C were significantly lower or less than those in group A ( P<0.05), but there were no statistical differences between group B and group C ( P>0.05). The time intervals of the first dilation after ESD were significantly different among the three groups (27.7±9.4 d VS 110.1±46.0 d VS 147.4±9.4 d, P<0.01). In pairwise comparison, the first dilation intervals in group B and group C were longer than that in group A ( P<0.01), and this indicator in group C was longer than that in group B ( P<0.01). Two patients in the control group developed perforation after ESD but they were treated actively and recovered finally. No severe ESD, steroid, or perforation related adverse events occurred in any other patient of the three groups. Conclusion:Both oral prednisone and oral prednisone combined with local injection of triamcinolone acetonide after ESD can effectively and safely prevent esophageal stricture after ESD. Oral administration combined with local injection of corticosteroids can prolong the time interval of the first dilation after ESD, which is beneficial to the psychological recovery and the improvement of patients’ life quality after the operation.