• Clinical Endoscopy
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• 제56권5호
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• pp.613-622
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases. Methods: This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality. Results: Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months. Conclusions: ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.

• Journal of Chest Surgery
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• 제53권4호
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• pp.172-177
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• 2020

Superficial esophageal neoplasms (SENs) are being diagnosed increasingly frequently due to the screening endoscopy and advances in endoscopic techniques. Endoscopic resection (ER) is a relatively noninvasive treatment method with low morbidity and mortality that provides excellent oncologic outcomes. Endoscopic submucosal dissection is associated with higher rates of en bloc, complete and curative resections and lower rates of local recurrence than endoscopic mucosal resection. The most serious complication of ER is stricture, the treatment and prevention of which are crucial to maintain the patient's quality of life. ER for SEN is feasible, effective, and safe and can be considered a first-line treatment for SENs in which it is technically feasible.

• Clinical Endoscopy
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• 제55권3호
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• pp.381-389
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• 2022

Background/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis. Methods: The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed. Results: ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85). Conclusions: ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

• Radiation Oncology Journal
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• 제35권3호
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• pp.241-248
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• 2017

Purpose: To evaluate the efficacy and safety of extended-field radiation therapy for patients with thoracic superficial esophageal cancer (SEC). Materials and Methods: From May 2007 to October 2016, a total of 24 patients with thoracic SEC (T1a and T1b) who underwent definitive radiotherapy and were analyzed retrospectively. The median total radiotherapy dose was 64 Gy (range, 54 to 66 Gy) in conventional fractionation. All 24 patients received radiotherapy to whole thoracic esophagus and 23 patients received elective nodal irradiation. The supraclavicular lymph nodes, the celiac lymph nodes, and both of those nodal areas were included in 11, 3, and 9 patients, respectively. Results: The median follow-up duration was 28.7 months (range 7.9 to 108.0 months). The 3-year overall survival, local control, and progression-free survival rates were 95.2%, 89.7%, and 78.7%, respectively. There were 5 patients (20.8%) with progression of disease, 2 local failures (8.3%) and 3 (12.5%) regional failures. Three patients also experienced distant metastasis and had died of disease progression. There were no treatment-related toxicities of grade 3 or higher. Conclusion: Definitive extended-field radiotherapy for thoracic SEC showed durable disease control rates in medically inoperable and endoscopically unfit patients. Even extended-field radiotherapy with elective nodal irradiation was safe without grade 3 or 4 toxicities.

• Clinical Endoscopy
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• 제56권1호
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• pp.55-64
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

• Journal of Digestive Cancer Research
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• 제8권1호
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• pp.71-75
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• 2020

식도암은 장막이 없어 암의 침윤 및 전이가 쉽고, 흉부의 가운데 있어 수술이 힘든 장기이다. 이로 인해 명확하게 가이드라인을 따라 치료를 하지 못하는 경우도 있다. 이런 상황에서 다학제 치료를 통해 식도암 환자에서 치료를 효율적으로 하고, 생존율을 향상시키고자 하는 노력이 증가하고 있다. 본 증례에서는 경부 식도 1곳과 흉부 식도 2곳으로 총 3곳에 표재성 식도암이 있는 환자에서 다학제 논의를 통해 수술 대신 항암방사선 동시 치료를 시행한 경우를 보고 한다. 또한 치료 중 확인된 복강 내 림프절에 대해 전이 여부 및 향후 치료 계획을 다시 다학제 모임을 통해 논의하였다. 이런 과정을 통해 환자는 완전 관해에 도달하였다. 본 증례를 통해 경부 식도에 위치한 조기식도암에 대해 항암방사선 동시 치료가 효과적일 수 있으며, 또한 식도암의 치료에 있어 다학제적 접근이 효율적임을 알리고자 한다. 아직 사망률이 높다고 인식되는 식도암에서, 향후 다학제 치료를 통해 더 많은 환자가 도움 받을 것으로 생각된다.

• Journal of Chest Surgery
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• 제37권8호
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• pp.665-671
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• 2004

배경: 흉부 식도암에서의 림프절 전이는 식도암이 점막하층에만 국한된 경우라도 흔하게 발견된다고 보고되고 있다. 림프절 전이가 수술 후의 예후에 큰 영향을 주고 있음에도 불구하고 조기식도암의 림프절 전이 양상은 완전히 조사되어 있지 않으며 림프절 절제술의 역할에 대해서도 여전히 의견이 분분하다. 대상 및 방법: 저자는 1995년 12월부터 2001년 8월까지 수술한 표층부(T1)식도암 환자 44예를 대상으로 림프절 전이의 양상을 후향적으로 연구하였다. 결과: 총 44예의 환자 중에서 림프절 전이는 총 10예(22.7%)에서 있었다. 식도암의 침윤 정도에 따라 볼 때 상피성 점막층에 국한된 경우 3예 중 0예, 점막고유 점막층까지 침윤된 경우 4예 중 0예, 근육성 점막층까지 침윤된 경우 4예 중 2예, 그리고 점막하층까지 침윤된 경우 33예 중 8예에서 림프절 전이가 발견되었다. 반회후두신경 림프절 전이는 5예, 복강내 림프절 전이가 8예에서 있어 흉부내 림프절 전이 3예보다 흔히 있었다. 수술사망은 없었고 병원사망이 점막고유층 환자에서 1예, 만기사망이 점막하식도암 환자에서 1예 있었다. 병원사망을 제외한 3년 생존율은 점막식도암이 100%, 점막하식도암은 97.0% (32/33예)였다(p＞0.05). 림프절 전이가 없는 환자들의 3년 생존율은 100%, 림프절 전이가 있는 환자들은 90.0% (9/10예)였다(p＞0.05). 결론: 표층부(T1) 식도암은 수술적 절제 후 생존율이 우수하다. 그러나 표층부(T1) 식도암에서 근육성 점막층 이상의 침윤이 있는 암에서는 림프절전이가 있을 수 있으며 특히 반회후두신경 림프절과 복강내 림프절 등 원격 림프절에도 빈번한 전이가 관찰되므로 광범위한 림프절 절제술이 필요하다고 생각된다.

• Journal of Chest Surgery
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• 제38권1호
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• pp.76-79
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• 2005

식도에서 간엽세포 종양과 상피성세포 종양의 공존은 매우 드물다 저자들은 식도 평활근종의 점막표면에 위치한 편평상피세포암 수술 치험 1예를 보고한다. 내원 3개월 전부터 음식 섭취시 연하통을 주소로 내원한 76세 남자 환자에서 수술 전 검사로 석회화를 동반한 식도 점막하종양을 의심하였고, 종양을 덮고 있는 불규칙한 점막의 식도내시경 조직검사로 편평상피세포암의 공존을 수술 전에 진단하였다. 우측 개흥과 개복으로 흉부 식도절제술 후 식도-위 문합을 시행하였다. 수술 25개월이 경과한 현재까지 재발의 소견 없이 정상 생활을 하고 있다. 두 종양 사이의 관계의 가능성과 빈도에 대해 문헌 고찰을 한다.