Objective To analyze the clinical characteristics of patients treated with esophagectomy following endoscopic submucosal dissection (ESD) for early stage esophageal cancer or precancerosis and the reasons for esophagectomy. Methods We retrospectively analyzed the clinical data of 57 patients who were treated with esophagectomy following ESD in West China Hospital and Shanxian Hygeia Hospital from January 2012 through October 2016. There were 42 males and 15 females at age of 65.4 (52–77) years. There were 15 patients of upper thoracic lesions, the middle thoracic lesions in 34 patients, and the lower thoracic lesions in 8 patients. Results The reasons for esophagectomy included 3 patients with residual tumor, 8 patients with local recurrence, 37 patients with esophageal stricture, and 9 patients with dysphagia, although the diameter was larger than 1.0 cm. The pathology after esophagectomy revealed that tumor was found in 16 patients, including 3 patients with residual tumor and 8 with recurrent tumor confirmed before esophagectomy, and 5 patients with new-found recurrent tumor. Conclusion In the treatment of early stage esophageal cancer or precancerosis, the major reasons for esophagectomy following ESD include esophageal stricture, abnormal esophageal dynamics, local residual or recurrence.
In this review, development and application of the minimally invasive esophagectomy(MIE) for esophageal cancer are discussed including the types of MIE procedures, short- and long- term outcome after MIE; as well the future of MIE is forecasted. Main procedures of MIE performed currently include esophagectomy via thoracoscopy and laparoscopy and cervical esophagogastrosty, Ivor-Lewis MIE via thoracoscopy and laparoscopy, and hiatal MIE. Ivor-Lewis MIE gradually becomes a standard surgical option for the cancer of distal esophagus or esophagogastric junction while the solution of intrathoracic anastomosis via thoracoscopy has achieved. Several methods of intrathoracic anastomosis are reported such as hand-sewn, circular stapler, side-to-side and triangular anastomosis. MIE could decrease operative blood loss, shorten hospital stay and ICU stay, reduce postoperative especially pulmonary complications, and harvest more lymph nodes compared to open esophagectomy. The long-term survival has been proved similar with that after open esophagectomy for esophageal cancer. MIE has developed rapidly in recent years with some aspects in future prospectively: individual MIE treatment and quality of life, fast track after surgery, and robot-assisted MIE, as well the endoscopic submucosal dissection for esophageal cancer is mentioned.
ObjectiveTo explore the application value of transoral snare traction in endoscopic submucosal dissection (ESD) for patients with early gastric cancer (EGC). Methods A total of 90 EGC patients admitted to Xinxiang Central Hospital from January 2020 to April 2023 were selected and randomized into a study group and a conventional group using a random number table method. The conventional group was received ESD, while the study group was received transoral snare traction in combination with ESD. Baseline data, treatment efficacy, as well as the serum inflammatory-stress factors [tumor necrosis factor alpha, interleukin-6, adrenocorticotropic hormone and cortisol, gastrointestinal hormones (motilin and gastrin), surgical indicators, gastrointestinal function recovery indicators before surgery and day 1 and 3 after surgery, postoperative complications, improvement in quality of life, and 2-year recurrence rate were compared between the two groups. The test level was set at α=0.05. ResultsThere were no statistically significant differences in age, gender, body mass index, disease duration, longest tumor diameter, lesion location, and tumor differentiation degree between the study group and the conventional group (P>0.05). The total effective rate of treatment in the study group was higher than that in the conventional group [95.6% (43/45) vs. 80.0% (36/45), χ2=5.075, P=0.024]. The results of repeated measures analysis of variance indicated that there were statistically significant differences in the levels of inflammatory-stress factors and gastrointestinal hormones between the study group and the conventional group across groups, time, and group-time interaction effects (P<0.05). The impact of time on inflammatory-stress factors and gastrointestinal hormones varied depending on the intervention measures (P<0.001). The levels of inflammatory-stress factors in the study group increased before surgery and then decreased, and were lower than those in the control group. Meanwhile, the levels of serum motilin and gastrin in the study group continuously decreased before surgery and were lower than those in the control group. The operation duration, recovery of bowel sounds, first exhaust, first defecation, and first meal time in the study group were shorter than those in the conventional group, and the intraoperative blood loss was lower than that in the conventional group (P<0.05). The overall complication rate in the study group was lower than that in the conventional group [4.4% (2/45) vs. 17.8% (8/45), χ2= 4.050, P=0.044], and the improvement rate in quality of life was higher than that in the conventional group [77.8% (35/45) vs. 57.8% (26/45), χ2=4.121, P=0.042]. There was no significant difference in the recurrence rate between the two groups after a 2-year follow-up [6.98% (3/43) vs. 17.07%(7/41), χ2=1.191, P=0.275]. ConclusionThe results of this study suggest that the treatment of early gastric cancer with transoral snare traction combined with ESD has significant efficacy, which can optimize surgical procedures, reduce inflammatory stress, improve gastrointestinal hormone levels, promote disease recovery, reduce the occurrence of complications, and achieve good short- and medium-term outcomes.