内镜黏膜下剥离术后追加外科手术治疗食管胃结合部腺癌的最佳时机分析

Analysis of the optimal timing for additional surgical treatment of adenocarcinoma of esophagogastric junction after endoscopic submucosal dissection

摘要:

目的 探讨不同时间间隔对非治愈性内镜切除食管胃结合部腺癌（AEGJ）追加外科手术临床病理和预后的影响，以明确从内镜黏膜下剥离术（ESD）到追加外科手术的最佳时机。方法 回顾性分析2012年1月－2019年2月237例初始诊断为食管胃结合部早癌和癌前病变接受ESD治疗的患者的临床资料。最终42例（17.72%，34例非治愈性切除和8例治愈性切除）连续随访的AEGJ患者在内镜术后追加了外科手术。根据ESD到追加外科手术的时间间隔分为3组，早期组18例（4周 ≤ N < 8周）、中期组13例（8周 ≤ N < 12周）和晚期组11例（N ≥ 12周）。随访时间为（47.21±13.23）个月。结果 3组患者ESD后一般资料比较，差异无统计学意义（P > 0.05）。3组患者外科手术的临床病历资料（如：手术时间、腹腔粘连、术中出血量、淋巴结清扫数目、术后肛门首次排气时间、术后首次饮水时间、术后首次进食时间、术后住院时间和术后并发症发生率）比较，差异无统计学意义（P > 0.05）。生存分析显示，晚期组3年无复发生存期（RFS）低于早期组（70.00%和88.20%），差异无统计学意义（P > 0.05），3组间术后3年总生存期（OS）比较，差异无统计学意义（P > 0.05）。结论 推荐非治愈性内镜切除术后早期干预（4～8周内追加外科手术），在不影响AEGJ手术安全性的情况下，可获得更好的预后。

Abstract:

Objective To investigate the effect of different time intervals on the clinicopathological data and prognosis of additional surgery for non-curative endoscopic resection of adenocarcinoma of esophagogastric junction (AEGJ), then determine the optimal timing from endoscopic submucosal dissection (ESD) to additional surgery.Methods A retrospective cohort study method was used. Follow-up data of 237 patients initially diagnosed with early cancer and precancerous lesions of esophagogastric junction who underwent ESD from January 2012 to February 2019 were analyzed. Finally, 42 patients (17.72%, including 34 cases of non-curative resection and 8 cases of curative resection) with AEGJ with continuous follow-up who underwent additional surgery after endoscopic resection were included in this study. According to the time interval from ESD to additional surgery, they were divided into 3 groups, namely the early group with 18 cases (4 weeks ≤ N < 8 weeks), the intermediate group with 13 cases (8 weeks ≤ N < 12 weeks) and the late group 11 cases (N ≥ 12 weeks). The follow-up time was (47.21 ± 13.23) months, and clinicopathological data and oncological results were compared among the three groups by retrospective analysis.Results There was no significant difference in general data among the three groups after ESD (P > 0.05). There was no significant difference in surgical clinical medical records among the three groups, such as operation time, abdominal adhesion, intraoperative bleeding, the number of lymph node dissections, the first postoperative anal exhaust time, the first postoperative water inflow time, the first postoperative eating time, postoperative hospital stay, and the incidence of postoperative complications (P > 0.05). Survival analysis showed that 3-year recurrence free survival (RFS) in the late group was less than that in the early group (70.00% and 88.20%), but there was no significant difference (P > 0.05), there was also no significant difference in the 3-year overall survival (OS) among the three groups during the follow-up period (P > 0.05).Conclusion Early intervention after non-curative endoscopic resection is recommended (with additional surgery within 4 to 8 weeks), which can achieve a better prognosis without affecting the surgical safety and effectiveness of adenocarcinoma of gastroesophageal junction.