Stomach and Intestine(Tokyo) Volume 49, Issue 8 (July 2014)

Long-term Prognosis of Superficial Esophageal Cancers of at Least 50mm in Diameter Treated by Endoscopic Submucosal Dissection Tsuneo Oyama 1 , Akiko Takahashi 1 , Manabu Takeuchi 2 , Ryu Ishihara 3 , Takeshi Yamashina 3 , Hiroyuki Ono 4 , Masaki Tanaka 4 , Ichirou Oda 5 , Seiichirou Abe 5 1Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan 2Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan 3Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan 4Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan 5Endoscopy Division, National Cancer Center Hospital, Tokyo Keyword: 表層拡大型 , 食道表在癌 , 食道扁平上皮癌 , ESD , 予後 pp.1182-1189
Published Date 2014/7/25
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 [Aim]The aim of this study was to assess the efficacy of ESD(endoscopic submucosal dissection)for ECCS of at least 50 mm in diameter and to evaluate long-term prognosis after ESD.

 [Patients and methods]A total of 138 patients with superficial ECCS of at least 50mm in diameter treated by ESD were enrolled in this retrospective study. The patients were recruited from five territorial hospitals between 2000 and 2013 : Saku Central Hospital, Niigata University Hospital, Osaka Medical Center for Cancer and Cardiovascular Diseases, Shizuoka Cancer Center, and the National Cancer Center Hospital.

 Patients included 118 males and 20 females, and the median age was 69years(42~88years). Cancers were located in the upper(11), mid(81), lower(43), and abdominal(3)esophagus. Macroscopic types were 0-IIa(1), IIb(12), and IIc(125). Additional treatments such as esophagectomy, CT(chemotherapy), RT(radiation therapy), and CRT(chemo/radiotherapy)were recommended for patients who had T1b ESCC.

 [Result 1. R0 resection rate and invasion depth]The en bloc resection rate was 99.3%(137/138)and the R0 resection rate was 88.4%(122/138). There were no serious complications requiring surgical management. Invasion depth was sub-classified on the basis of the Japan Esophageal Society guidelines. The invasion depths for cancers classified as T1a-EP, T1a-LPM, T1a-MM, T1b-SM1(≦200μm), and T1b-SM2 were 30, 51, 34, 5, and 18, respectively.

 [Result 2. Local recurrence]The local recurrence rate was 0.7%(1/138). This patient had T1b-SM2 ESSC, but refused additional treatment. Local recurrence was diagnosed 51 months after ESD, and esophagectomy was performed.

 [Result 3. Prognosis]A total of 16 patients were treated with additional therapy(RT=1, CRT=15), and currently, all of them are well with no evidence of recurrence. All other patients were followed up without additional therapy. Four of these patients died of esophageal cancer and 18 of other diseases. Cause-specific and overall 5-year survival rates for T1a-MM, T1b-SM1, and T1b-SM2 were 90/71%, 67/67%, and 90/67%, respectively.

 [Conclusion]ESD is a safe and effective treatment for ECCS of at least 50mm in diameter. The prognosis of T1a-EP and T1a-LPM is excellent. The prognosis of T1a-MM, T1b-SM1, and T1b-SM2 is also excellent when appropriate additional therapy is provided.

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49巻8号 (2014年7月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院