RESUMO
BACKGROUND: Treatment of local recurrent or residual superficial esophageal squamous-cell carcinoma (SCC) with conventional EMR often results in a piecemeal resection that requires further intervention. OBJECTIVE: The aim of this study was to evaluate the efficacy of endoscopic submucosal dissection (ESD). DESIGN: A case series. PATIENTS: Between January 2006 and September 2006, 4 local recurrent or residual superficial esophageal SCCs were treated by ESD. INTERVENTIONS: ESD procedures were performed by using a bipolar needle knife and an insulation-tipped knife. After injection of glycerol into the submucosal (sm) layer, a circumferential incision was made, and an sm dissection was performed. All lesions were determined to be intramucosal or sm superficial, without lymph-node metastasis by EUS before treatment. MAIN OUTCOME MEASUREMENTS: Tumor size, en bloc resection rate, tumor-free lateral margin rates, and complications were recorded. RESULTS: All 4 ESD cases were successfully resected en bloc, and the tumor-free lateral margin rate was 75% (3/4) by histopathology examination. The mean tumor size of the resected specimens was 35 mm (range, 15-50 mm). There were no complications. LIMITATIONS: The number of ESDs in our series was limited, and there are no long-term follow-up data. CONCLUSIONS: ESD for recurrent or residual superficial esophageal tumors after chemoradiotherapy achieves the goal of an en bloc resection, with a low rate of incomplete treatment without any greater risk than the EMR technique.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Dissecação/métodos , Endoscopia Gastrointestinal , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Mucosa , RecidivaAssuntos
Alprostadil/uso terapêutico , Colite Isquêmica/complicações , Colite Isquêmica/tratamento farmacológico , Colo/patologia , Vasodilatadores/uso terapêutico , Alprostadil/administração & dosagem , Colo/irrigação sanguínea , Colonoscopia , Corantes , Constrição Patológica , Feminino , Humanos , Verde de Indocianina , Infusões Intravenosas , Mucosa Intestinal/irrigação sanguínea , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Vasodilatadores/administração & dosagemRESUMO
A 38-year-old woman presented to our hospital with the chief complaint of dyspnea. A chest radiograph showed pleural effusion of the right lung and a CT scan revealed liver metastasis. A tumor biopsy done under bronchoscopy revealed large-cell carcinoma of the lungs. She was given 4 courses of a combination therapy consisting of CDDP (80 mg/m2) and vinorelbine (25 mg/m2). The primary tumor in the right lung and liver metastasis were markedly reduced in size and a partial response was obtained. The combination therapy of CDDP and vinorelbine may become a standard chemotherapy for advanced non-small cell lung cancer.
