Background: Multicentric squamous dysplasia is frequent in the esophagus and c an be visualized by chromoendoscopy(Lugol’s solution) as multiple Lugol-voidin g lesi- ons (LVLs).Although EMR commonly is used to treat ...Background: Multicentric squamous dysplasia is frequent in the esophagus and c an be visualized by chromoendoscopy(Lugol’s solution) as multiple Lugol-voidin g lesi- ons (LVLs).Although EMR commonly is used to treat superficial esophageal cance r, new lesions can arise and incomplete resection can result in residual disease . Little is known about the risk factors for local recurrence or the appropriate treatment for recurrent lesions. Methods: A total of 116 consecutive patients w ith a total of 165 esophageal squamous-cell carcinomaswere studied retrospectiv ely. Follow-up examination by means of chromoendoscopy(Lugol’s solution) and b iopsies was performed every 3 months during the first year after EMR and every 6 months thereafter. Lesions were defined as a local recurrence when cancer was d etected at the site of the EMR scar. Risk factors associated with local recurren ce were investigated by using logistic analysis. Results: At a median follow-up of 35 months (range 12-110 months), local recurrence was detected for 33(20%) of 165 lesions. Of the patient-related factors, multivariate logistic analysis showed that multiple LVLs (OR 3.1: 95%CI[1.1, 8.5]; p = 0.03) was an independe nt risk factor for local recurrence after EMR. The cumulative local recurrence r ates at 3 years in patients with multiple LVLs and those without multiple LVLs w ere 39%and 14%(p< 0.01), respectively. All of the recurrent lesions except two could be removed by EMR,which was not associated with any serious complication. The remaining two patients had chemoradiotherapy. Overall causespecific surviva l at 3 years was 100%. Conclusions: Patients with multiple LVLs are at risk of local recurrence after EMR.Although careful long-term endoscopic follow-up is needed for su- ch patients, EMR is potentially curative for recurrent lesions.展开更多
文摘Background: Multicentric squamous dysplasia is frequent in the esophagus and c an be visualized by chromoendoscopy(Lugol’s solution) as multiple Lugol-voidin g lesi- ons (LVLs).Although EMR commonly is used to treat superficial esophageal cance r, new lesions can arise and incomplete resection can result in residual disease . Little is known about the risk factors for local recurrence or the appropriate treatment for recurrent lesions. Methods: A total of 116 consecutive patients w ith a total of 165 esophageal squamous-cell carcinomaswere studied retrospectiv ely. Follow-up examination by means of chromoendoscopy(Lugol’s solution) and b iopsies was performed every 3 months during the first year after EMR and every 6 months thereafter. Lesions were defined as a local recurrence when cancer was d etected at the site of the EMR scar. Risk factors associated with local recurren ce were investigated by using logistic analysis. Results: At a median follow-up of 35 months (range 12-110 months), local recurrence was detected for 33(20%) of 165 lesions. Of the patient-related factors, multivariate logistic analysis showed that multiple LVLs (OR 3.1: 95%CI[1.1, 8.5]; p = 0.03) was an independe nt risk factor for local recurrence after EMR. The cumulative local recurrence r ates at 3 years in patients with multiple LVLs and those without multiple LVLs w ere 39%and 14%(p< 0.01), respectively. All of the recurrent lesions except two could be removed by EMR,which was not associated with any serious complication. The remaining two patients had chemoradiotherapy. Overall causespecific surviva l at 3 years was 100%. Conclusions: Patients with multiple LVLs are at risk of local recurrence after EMR.Although careful long-term endoscopic follow-up is needed for su- ch patients, EMR is potentially curative for recurrent lesions.
