AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane...AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.展开更多
目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规...目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规入路组44例行经左胸两切口(左胸—颈部)入路手术,右胸入路组45例行经右胸3切口(上腹部—右胸—颈部)入路手术,对比两组患者围手术期指标、疼痛指标、肺功能、并发症情况。结果两组术后引流时间、总住院时间、术中所见淋巴结转移数水平比较差异无统计学意义(P>0.05);右胸入路组手术时间、术中出血量、淋巴结清扫数水平高于常规入路组(P<0.05)。两组患者术后72 h SP、NPY水平较术前升高,右胸入路组低于常规入路组(P<0.05)。两组患者术后1个月肺活量(VC)、用力肺活量(FVC)、1 s用力肺活量(FEV1)、最大通气量(MVV)水平较术前降低,右胸入路组高于常规入路组(P<0.05)。经Fisher确切概率法检验,右胸入路组并发症发生率11.11%(5/45)与常规入路组6.82%(3/44)比较,差异无统计学意义(P>0.05)。结论与左胸入路手术相比,右胸入路手术的手术时间较长,术中出血量较多,但淋巴结清扫数高,可调节胸中段老年食管癌患者肺功能,改善疼痛指标,有良好安全性。展开更多
文摘AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.
文摘目的探索左右胸不同入路手术对胸中段老年食管癌患者P物质(SP)、神经肽Y(NPY)水平及肺功能的影响。方法选取我院2018年1月至2020年12月收治的89例胸中段老年食管癌患者作为研究对象,依照不同入路手术分为常规入路组和右胸入路组。常规入路组44例行经左胸两切口(左胸—颈部)入路手术,右胸入路组45例行经右胸3切口(上腹部—右胸—颈部)入路手术,对比两组患者围手术期指标、疼痛指标、肺功能、并发症情况。结果两组术后引流时间、总住院时间、术中所见淋巴结转移数水平比较差异无统计学意义(P>0.05);右胸入路组手术时间、术中出血量、淋巴结清扫数水平高于常规入路组(P<0.05)。两组患者术后72 h SP、NPY水平较术前升高,右胸入路组低于常规入路组(P<0.05)。两组患者术后1个月肺活量(VC)、用力肺活量(FVC)、1 s用力肺活量(FEV1)、最大通气量(MVV)水平较术前降低,右胸入路组高于常规入路组(P<0.05)。经Fisher确切概率法检验,右胸入路组并发症发生率11.11%(5/45)与常规入路组6.82%(3/44)比较,差异无统计学意义(P>0.05)。结论与左胸入路手术相比,右胸入路手术的手术时间较长,术中出血量较多,但淋巴结清扫数高,可调节胸中段老年食管癌患者肺功能,改善疼痛指标,有良好安全性。
