Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11325
Peer-review started: June 24, 2022
First decision: September 2, 2022
Revised: September 13, 2022
Accepted: September 27, 2022
Article in press: September 27, 2022
Published online: November 6, 2022
Processing time: 124 Days and 23.3 Hours
Although early esophageal squamous cell carcinoma (EESCC) with cirrhosis is a relatively rare clinical phenomenon, the management of EESCC in cirrhotic patients continues to be a challenge.
To evaluate the feasibility, safety, efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection (ESTD) for treating EESCC in patients with cirrhosis.
This was a single-center retrospective cohort study. We examined 590 EESCC patients who underwent ESTD between July 14, 2014, and May 26, 2021, from a large-scale tertiary hospital. After excluding 25 patients with unclear lesion areas or pathological results, the remaining 565 patients were matched at a ratio of 1:3 by using propensity score matching. A total of 25 EESCC patients with comorbid liver cirrhosis and 75 matched EESCC patients were ultimately included in the analysis. Parametric and nonparametric statistical methods were used to compare the differences between the two groups. The Kaplan–Meier method was used to create survival curves, and differences in survival curves were compared by the log-rank test.
Among 25 patients with liver cirrhosis and 75 matched noncirrhotic patients, there were no significant differences in intraoperative bleeding (P = 0.234), 30-d post-ESTD bleeding (P = 0.099), disease-specific survival (P = 0.075), or recurrence-free survival (P = 0.8196). The mean hospitalization time and costs were significantly longer (P = 0.007) and higher (P = 0.023) in the cirrhosis group than in the noncirrhosis group. The overall survival rate was significantly lower in the cirrhosis group (P = 0.001).
ESTD is technically feasible, safe, and effective for patients with EESCC and liver cirrhosis. EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.
Core Tip: Endoscopic submucosal tunnel dissection (ESTD) is a modification of traditional endoscopic submucosal dissection that provides a clear visual field and sufficient operative space through the submucosal tunnel. In the present cohort study, we found that ESTD can be safely performed in patients with early esophageal squamous cell carcinoma (EESCC) and cirrhosis without increasing the risk of intraoperative and postoperative bleeding. In addition, the disease-specific survival and recurrence-free survival of cirrhosis patients were comparable to those of general patients. Finally, we also found that EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.