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Simultaneous endoscopic submucosal dissection for synchronous multiple early esophageal squamous cell carcinoma: a propensity score-matched analysis

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Abstract

Background

The clinical effect of endoscopic submucosal dissection (ESD) in the treatment of early esophageal squamous cell carcinoma (EESCC) is widely recognized. However, the long-term treatment outcome of simultaneous ESD for multiple EESCC currently remained unknown. Hence, this study was aimed at further evaluating the long-term outcome of simultaneous ESD for synchronous multiple EESCC by comparing with ESD for single EESCC.

Methods

Consecutive patients who underwent ESD for EESCC from June 2008 to June 2018 were included. Propensity score-matched analysis was used to compensate for the differences in age, sex, tumor location, tumor size, and tumor invasion depth between simultaneous and single ESD groups. Treatment outcomes including en bloc resection rate, curative resection rate, complication rate, and long-term outcomes including overall survival (OS), recurrence-free survival (RFS), metachronous recurrence were compared between the 2 groups after matching.

Results

The propensity score-matched analysis included 332 lesions (166 patients) and 332 lesions (332 patients) in simultaneous and single ESD groups, respectively. Among all the outcomes, en bloc resection, curative resection, 5-year OS, and 5-year RFS rates were comparable. Complications were more common in the simultaneous ESD group (15.06% vs. 9.64%, P = 0.073). The 5-year metachronous recurrence rates were significantly high in the simultaneous ESD groups (24.28% vs. 6.99%).

Conclusions

Simultaneous ESD is an effective and safe methodology for synchronous multiple EESCC; it also reduces hospital stay and medical expenses. The risk of metachronous recurrence is higher for patients with synchronous multiple EESCC; thus, more intensive strategies are required.

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Acknowledgements

This project supported by the National Key R&D Program of China (2019YFC1315800,2019YFC1315802), National Natural Science Foundation of China (81861168036, 81702305), and the National Key R&D Program of China (2018YFC1315000, 2018YFC1315005). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Di Sun and Qiang Shi have contributed equally to this work.

Authors and Affiliations

  1. Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China

    Di Sun, Qiang Shi, ZhiPeng Qi, Bing Li, Shilun Cai, Pinghong Zhou & Yunshi Zhong

  2. Endoscopy Research Institute of Fudan University, Shanghai, 200032, China

    Di Sun, Qiang Shi, ZhiPeng Qi, Bing Li, Shilun Cai, Pinghong Zhou & Yunshi Zhong

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  1. Di Sun
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Correspondence to Pinghong Zhou or Yunshi Zhong.

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Drs. Sun Di, Shi Qiang, Qi ZhiPeng, Li Bing, Cai Shilun, Zhou Pinghong, and Zhong Yunshi have no conflicts of interest or financial ties to disclose.

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Sun, D., Shi, Q., Qi, Z. et al. Simultaneous endoscopic submucosal dissection for synchronous multiple early esophageal squamous cell carcinoma: a propensity score-matched analysis. Surg Endosc 36, 109–116 (2022). https://doi.org/10.1007/s00464-020-08243-7

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