Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer: a multicenter retrospective study.

Autor: Joseph A; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Vantanasiri K; Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Draganov PV; Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA., King W; Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA., Maluf-Filho F; Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil; Department of Gastroenterology of University of Sao Paulo, Sao Paulo, São Paulo, Brazil; National Council for Scientific and Technological Development, Lago Sul, Brazil., Al-Haddad M; Department of Gastroenterology, Indiana University, Indianapolis, USA., Albunni H; Department of Gastroenterology, Indiana University, Indianapolis, USA., Fukami N; Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA., Mohapatra S; Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA., Aihara H; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA., Sharma NR; Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA., Chak A; Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Yang D; Department of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA., Singh R; Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA., Jang S; Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA., Kamath S; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA., Raja S; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA., Murthy S; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA., Yang Q; Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA., Iyer P; Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Bhatt A; Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2024 May; Vol. 99 (5), pp. 694-701. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1016/j.gie.2023.11.047
Abstrakt: Background and Aims: Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC.
Methods: Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs.
Results: A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008).
Conclusion: Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.
Competing Interests: Disclosure The following authors disclosed financial relationships: F. Maluf-Filho: Consultant for Boston Scientific, Cook, and Olympus America. P. V. Draganov: Consultant for Boston Scientific, Cook, Medtronic, Olympus, Fujifilm, MicroTech, and Merit. M. Al-Haddad: Research support from Amplified Sciences LLC, Cook Endoscopy, and Creatics LLC; consulting and teaching for Interpace Diagnostics. N. Fukami: Consultant for Boston Scientific and Olympus America. H. Aihara: Consultant for Boston Scientific, Fujifilm Medical Systems, Medtronics, ConMed, Creo Medical and 3-D Matrix. N. R. Sharma: Consultant for Covidien, Boston Scientific, Mauna Kea Technologies, US Endoscopy, and Merck Sharp & Dohme Corporation. A. Chak: Consultant for US Endoscopy and investment interest in Lucid Diagnostics. D. Yang: Consultant for Lumendi, Boston Scientific, and Steris. R. Singh: Consultant for Exelixis and Tempus. All other authors disclosed no financial relationships.
(Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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