The Long-term Prognosis after Endoscopic Submucosal Dissection of Esophageal Adenocarcinoma Arising from Barrett's Esophagus:Focusing on Long-Segment Barrett's Esophagus Akiko Takahashi 1 , Tsuneo Oyama 1 1Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan Keyword: LSBE , Barrett食道腺癌 , 長期予後 , 異時多発癌 , stepwise ESD pp.196-206
Published Date 2021/2/25
DOI https://doi.org/10.11477/mf.1403202250
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 Among the adenocarcinomas arising from long-segment Barrett's esophagus(LSBE; Prague classification M3 or longer)treated by ESD(endoscopic submucosal dissection)during the period from January 2000 to September 2017 at our hospital, we included 20 lesions in 16 patients with a confirmed follow-up of 3 years or more(median follow-up observation period of 128 months).

 The median tumor diameter was 36mm, and the median resected specimen diameter was 86mm. The invasion depth of the primary lesion was T1a-SMM in 1 patient, T1a-LPM in 1 patient, T1a-DMM in 12 patients, and T1b-SM1 in 2 patients. The histological types were differentiated in all patients. The rate of en bloc resection was 95%, and all patients were negative for vascular invasion(ly, v). Four of the 16 patients presented with a synchronous multiple cancers(25%).

 Of the 16 patients, circumferential and localized resection were performed in 7 and 9 patients, respectively. Patients who underwent circumferential resection did not have not only metachronous cancers but also recurrence of Barrett's esophagus. In six of the nine patients who underwent localized resection, follow-up was performed, and two of these patients(33%)exhibited metachronous cancers. In these two patients, residual Barrett's mucosa was ≥3cm in length, and in the remaining four patients who did not have metachronous cancers, residual Barrett's mucosa was short(<3cm). Therefore, large residual Barrett's mucosa(M3 or longer)was a risk factor of metachronous cancer.

 In the remaining three patients who underwent localized resection, stepwise ESD was performed for the residual Barrett's mucosa to prevent metachronous cancers. In these three patients, no postoperative stenosis or recurrence of Barrett's mucosa was observed.

 In the 16 patients with esophageal adenocarcinoma arising from LSBE who were treated by ESD, there was no death from the underlying illness, and the disease-specific survival rates at 3 and 5 years were 100%. Furthermore, the overall survival rates at 3 years and 5 years were also 100%.

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