https://scholars.lib.ntu.edu.tw/handle/123456789/540978
標題: | Radiofrequency ablation versus endoscopic submucosal dissection in treating large early esophageal squamous cell Neoplasia | 作者: | Wang W.-L. Chang I.-W. CHIEN-CHUAN CHEN Chang C.-Y. Mo L.-R. Lin J.-T. HSIU-PO WANG Lee C.-T. |
公開日期: | 2015 | 出版社: | Lippincott Williams and Wilkins | 卷: | 94 | 期: | 49 | 來源出版物: | Medicine (United States) | 摘要: | Radiofrequency ablation (RFA) and endoscopic submucosal dissection (ESD) can potentially be applied for early esophageal squamous cell neoplasia (ESCN); however, no study has directly compared these 2 modalities. We retrospectively enrolled the patients with flat-type large (length ?3 cm extending ?1/2 of the circumference of esophagus) early ESCNs treated endoscopically. The main outcome measurements were complete response at 12 months, and adverse events. Of a total of 65 patients, 18 were treated with RFA and 47 with ESD. The procedure time of RFA was significantly shorter than that of ESD (126.6 vs 34.8 min; P<0.001). The complete resection rate of ESD and complete response rate after primary RFA were 89.3% and 77.8%, respectively. Based on the histological evaluation of the post-ESD specimens showed 14 of 47 (29.8%) had histological upstaging compared with the pre-ESD biopsies, and 4 of them had lymphovascular invasion requiring chemoradiation or surgery. After additional therapy for residual lesions, 46 (97.9%) patients in the ESD group and 17 (94.4%) patients in the RFA group achieved a complete response at 12 months. Four patients (8.5%) developed major procedure-related adverse events in the ESD group, but none in the RFAgroup. In patientswith lesions occupyingmore than 3/4 of the circumference, a significantly higher risk of esophageal stenosis was noted in the ESD group compared with RFA group (83% vs 27%, P=0.01), which required more sessions of dilatation to resolve the symptoms (median, 13 vs 3, P=0.04). There were no procedure-related mortality or neoplastic progression in either group; however, 1 patient who received ESD and 1 who received RFA developed local recurrence during a median follow-up period of 32.4 (range, 13-68) and 18.0 (range, 13-41) months, respectively. RFA and ESD are equally effective in the short-term treatment of early flat large ESCNs; however, more adverse events occur with ESD, especially in lesions extending more than 3/4 of the circumference. RFA does not allow for pathology to evaluate the curability after ablation, and thus currently the use for invasive ESCNs should be conservative until longer follow-up studies are available. ? 2015 Wolters Kluwer Health, Inc. All rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84952656034&doi=10.1097%2fMD.0000000000002240&partnerID=40&md5=61fb88ab2aaa0a47d40df91670b01a45 https://scholars.lib.ntu.edu.tw/handle/123456789/540978 |
ISSN: | 0025-7974 | DOI: | 10.1097/MD.0000000000002240 | SDG/關鍵字: | adult; aged; Article; balloon dilatation; cancer mortality; cancer staging; chemoradiotherapy; cohort analysis; comparative study; dissector; early cancer; endoscopic submucosal dissection; esophageal squamous cell carcinoma; esophagoscope; esophagus biopsy; esophagus hemorrhage; esophagus perforation; esophagus stenosis; female; follow up; histopathology; human; lymph vessel metastasis; major clinical study; male; operation duration; outcome assessment; patient safety; pneumomediastinum; postoperative hemorrhage; priority journal; radiofrequency ablation; radiofrequency ablation device; retrospective study; short course therapy; treatment response; tumor recurrence; tumor volume; adverse effects; body mass; catheter ablation; dissection; drinking behavior; Esophageal Neoplasms; esophagoscopy; middle aged; Neoplasms, Squamous Cell; pathology; procedures; smoking; Adult; Aged; Alcohol Drinking; Body Mass Index; Catheter Ablation; Dissection; Esophageal Neoplasms; Esophagoscopy; Female; Humans; Male; Middle Aged; Neoplasms, Squamous Cell; Operative Time; Retrospective Studies; Smoking |
顯示於: | 醫學系 |
在 IR 系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。