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目的探讨早期食管癌患者行内镜下切除术(ER)后是否需要二次行食管癌根治术的影响因素。方法选择2011年6月至2014年3月在复旦大学附属肿瘤医院胸外科收治的经ER手术治疗的早期食管癌患者,根据是否继续行食管癌根治术分组并随访,对食管癌根治术后未见癌残留的病例进行包括浸润深度(T分期)、病灶长度(<3cm或≥3cm)、病灶位置(上、中、下段)、分化程度以及有无淋巴管脉管侵犯的相关性统计分析,统计学方法采用χ~2检验。结果共有88例患者术前检查和分期提示为早期食管癌患者接受ER术,再次行食管癌根治术有22例(25.0%),其中7例(31.8%)最终病理未见肿瘤残留。统计学分析显示:ER病灶浸润深度(T0-1a期或T1b期以上)对于是否需行二次根治术具有预测作用(χ~2=8.56,P=0.005),而病灶长度、位置、分化程度以及有无淋巴管脉管侵犯未见明显影响(χ~2=1.89,P=0.361;χ~2=3.01,P=0.165;χ~2=3.85,P=0.121;χ~2=1.02,P=1.000)。结论根据ER术后的病理结果:T0-1a且切缘为阴性的患者,食管切除多能避免;而T1a以上,特别是内镜黏膜下剥离术(ESD)中黏膜下注射亚甲蓝抬举不满意或内镜下黏膜切除术(EMR)圈套不满意者,推荐行食管癌根治术。对于贲门处的早期癌,ER手术的选择要慎重。
Objective To investigate the influencing factors of esophageal cancer radical mastectomy after endoscopic resection (ER) in patients with early esophageal cancer. Methods From June 2011 to March 2014, patients with early esophageal cancer treated by ER surgery admitted to Thoracic Surgery Hospital Affiliated Tumor Hospital of Fudan University were divided into two groups based on whether esophageal cancer radical resection and follow-up were performed. See cancer residual cases, including the depth of invasion (T stage), the length of the lesion (<3cm or ≥ 3cm), the location of the lesion (upper, middle and lower), the degree of differentiation and the presence or absence of lymphatic vessel invasion correlation analysis, Statistical methods using χ ~ 2 test. Results A total of 88 patients underwent preoperative examination and staging of esophageal cancer, and 22 patients (25.0%) underwent radical esophagectomy again. Of the 7 patients (31.8%), no tumor remained in the final pathology. Statistical analysis showed that the depth of invasion (T0-1a or T1b) was predictive of whether the second radical operation was required (χ ~ 2 = 8.56, P = 0.005), while the length of the lesion, location, degree of differentiation (P = 0.361; χ ~ 2 = 3.01, P = 0.165; χ ~ 2 = 3.85, P = 0.121; χ ~ 2 = 1.02, P = 1.000). Conclusions Esophagectomy can be avoided in patients with T0-1a and negative margins according to the pathological findings after ER: more submucosal injection of methylene blue in T1a or above, especially in endoscopic submucosal dissection (ESD) Satisfactory or endoscopic mucosal resection (EMR) trap are not satisfied, recommended esophageal cancer radical mastectomy. For cardia early cancer, the choice of ER surgery should be cautious.