Outcomes of Endoscopic Submucosal Dissection vs Esophagectomy for T1 Esophageal Squamous Cell Carcinoma in a Real-World Cohort

Zhang, Yiqun; Ding, Han‐Fei; Chen, Tao; Zhang, Xiaocen; Chen, Weifeng; Li, Quan‐Lin; Yao, Ling; Korrapati, Praneet; Jin, Xuejuan; Zhang, Yongxing; Xu, Mei‐Dong; Zhou, Ping‐Hong

doi:10.1016/j.cgh.2018.04.038

Cited by 81 publications

(95 citation statements)

References 55 publications

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“…This would largely preserve patient short‐ and long‐term quality of life. Although the application of MIE largely reduced postoperative complications, severe complication rates in the patients who underwent ESD were even lower . In addition, hospital stay duration and the total cost were much less in the ESD group compared with the MIE group.…”

Section: Discussionmentioning

confidence: 49%

“…Although the application of MIE largely reduced postoperative complications, 14 severe complication rates in the patients who underwent ESD were even lower. 15 In addition, hospital stay duration and the total cost were much less in the ESD group compared with the MIE group. These factors might be important when considering patients with comorbidities or those advanced in age.…”

Section: Discussionmentioning

confidence: 91%

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Comparison of the therapeutic effects of endoscopic submucosal dissection and minimally invasive esophagectomy for T1 stage esophageal carcinoma

et al. 2019

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Background In recent years, diagnosis of early squamous cell carcinoma of the esophagus has been increasingly emphasized. The application of endoscopic submucosal dissection (ESD) has enabled safe resection of esophageal lesions. Minimally invasive esophagectomy (MIE) is also safe and feasible for early stages of the cancer. This study aimed to compare the therapeutic effects of early esophageal carcinoma treatment, and find the best predictive factor for the selection of treatment for T1a patients. Methods We performed a retrospective study of early‐stage patients admitted to Tianjin Medical University Cancer Institute and Hospital between January 2015 and December 2018. A total of 128 patients underwent MIE, while 78 patients underwent ESD. The depth of the tumor invasion, lymph node metastasis, and complications were compared between the two groups. Results In the ESD group, 76.92% of the patients were stage T1a, while 34.38% in the MIE group were stage T1a. The lymph node metastasis rate was 16.41% in the MIE group (6.98% in T1a stage), which related to tumor differentiation, tumor length (≥37.5 mm), depth of invasion, and angiolymphatic invasion. However, the R0 resection rate was only 73.08% in the ESD group. Comprehensive analysis of all T1 patients in the two groups revealed that the positive margin was related to tumor differentiation, tumor width (≥13.5 mm), and depth of invasion (≥3.25 mm). Conclusion For early‐stage cases, lymph node metastasis and positive margins are risk factors affecting long‐term survival. Efficient predictive factors mentioned in our study would provide a proper indication for treatment strategy selection.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 91%

Comparison of the therapeutic effects of endoscopic submucosal dissection and minimally invasive esophagectomy for T1 stage esophageal carcinoma

et al. 2019

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“…Our results add to the evidence that supports the use of ESD for the treatment of Barrett's neoplasia . The nature of EMR limits the endoscopist's ability to accurately and consistently control the depth of resection and ESD has been suggested as an alternative that allows for better visualization of depth of both the lesion and resection plane . Unfortunately, direct comparisons between ESD and EMR for the treatment of Barrett's neoplasia are limited to relatively small studies or extrapolations from treatment of superficial squamous cell carcinoma of the esophagus .…”

Section: Discussionmentioning

confidence: 99%

“…11,14,15,17,19,24 The nature of EMR limits the endoscopist's ability to accurately and consistently control the depth of resection and ESD has been suggested as an alternative that allows for better visualization of depth of both the lesion and resection plane. 20,22,23,[25][26][27][28][29][30] Unfortunately, direct comparisons between ESD and EMR for the treatment of Barrett's neoplasia are limited to relatively small studies or extrapolations from treatment of superficial squamous cell carcinoma of the esophagus. 14,15,29 In a metanalysis of eight Eastern studies, Guo et al demonstrated significantly lower rates of recurrence in superficial esophageal cancers resected via ESD when compared to EMR.…”

Section: Discussionmentioning

confidence: 99%

“…20,22,23,[25][26][27][28][29][30] Unfortunately, direct comparisons between ESD and EMR for the treatment of Barrett's neoplasia are limited to relatively small studies or extrapolations from treatment of superficial squamous cell carcinoma of the esophagus. 14,15,29 In a metanalysis of eight Eastern studies, Guo et al demonstrated significantly lower rates of recurrence in superficial esophageal cancers resected via ESD when compared to EMR. 14 16 The overall numbers were relatively small (20 EMR and 20 ESD) and a detailed analysis of pathology samples was not reported.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett's‐related neoplasia

Podboy

Kolahi

Friedland

et al. 2019

Digestive Endoscopy

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Background & Aims Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have demonstrated similar efficacy in removal of neoplastic esophageal lesions. However, significant controversy exists over the preferred resection technique. Our primary aim was to compare the pathologic specimens produced via EMR and ESD and secondarily gauge their effect on clinical decision making and patient outcomes. Methods Using a retrospective cohort study design, all esophageal Barrett's‐associated neoplastic lesions resected by a single provider from 2012 to 2017 were reviewed. The pathology was re‐reviewed by two blinded authors for diagnosis, margins, and adverse outcomes and recurrence rates were also collected. Results Thirty‐one EMR and 20 ESD cases were identified. Baseline demographics and lesion characteristics were similar. ESD produced more R0 resections and more en bloc resections compared to EMR. EMR produced more equivocal lateral (13/31, 41.9% vs 1/20, 5.0%) and vertical margins (13/31, 41.9% vs. 0/20, 0%, both P < 0.05). This led to an inability to reach a definitive diagnosis in 13/31 EMR vs 0/20 ESD pathology specimens (P = 0.003). Of the 13 EMR specimens with equivocal pathology, 11 were noted to have ‘at least intramucosal adenocarcinoma’. Four of the 11 patients chose to undergo elective esophagectomy with final surgical pathology demonstrating ≤T1a disease in 2, and ≥T1b disease in two. Conclusion Compared to ESD, EMR was associated with greater pathologic uncertainty in Barrett's‐associated neoplasia.

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Precision in Thermal Therapy: Clinical Requirements and Solutions from Nanotechnology

Gschwend

Hintze

Herrmann

et al. 2021

Advanced Therapeutics

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The heating of diseased tissue as a therapeutic measure has gained increased clinical attention, mostly due to its target-specificity that minimizes side effects. However, to ensure a successful therapy, heating has to be homogeneous and highly localized, as well as, within a certain temperature range. Therefore, precise control over thermal treatments is a clinical prerequisite to minimize treatment and safety margins. Although this requirement is mentioned frequently, past research has focused predominantly on improving thermometry resolution and heating efficiency through tedious material optimization. Here, current clinical applications of thermal therapy with their challenges are first highlighted, especially with respect to treatment control and margins. Thereafter, it is quantitatively shown that clinically available thermometry fulfills the requirements and future research should focus on achieving better temperature control instead. With nanotechnology, novel strategies based on self-limiting nanoparticle systems and particle-based thermometers with active feedback control have also become available and are discussed. All of these approaches are systematically compared and analyzed with respect to their clinical applicability. The extent to which control over thermal therapy is necessary is also discussed alongside a presentation of the existing methods which fulfill the set requirements for clinical success and what issues remain to be tackled by research in the near future.

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Outcomes of Endoscopic Submucosal Dissection vs Esophagectomy for T1 Esophageal Squamous Cell Carcinoma in a Real-World Cohort

Cited by 81 publications

References 55 publications

Comparison of the therapeutic effects of endoscopic submucosal dissection and minimally invasive esophagectomy for T1 stage esophageal carcinoma

Comparison of the therapeutic effects of endoscopic submucosal dissection and minimally invasive esophagectomy for T1 stage esophageal carcinoma

Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett's‐related neoplasia

Precision in Thermal Therapy: Clinical Requirements and Solutions from Nanotechnology

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