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Ryu DG, Yun MS, Liu H, Lee SS, Lee SL. Clinical outcomes of esophageal squamous cell carcinoma in patients with cirrhosis. Clin Transl Radiat Oncol 2024; 48:100817. [PMID: 39114581 PMCID: PMC11304692 DOI: 10.1016/j.ctro.2024.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose Alcohol consumption is a strong risk factor for both cirrhosis and esophageal squamous cell carcinoma (ESCC). Few studies have been conducted on the treatment of ESCC in patients with cirrhosis. This study aimed to analyze the clinical outcomes of ESCC in patients with cirrhosis. Materials and methods Medical records of patients with esophageal cancer between January 2009 and December 2023 were retrospectively reviewed. A total of 479 patients with ESCC were included and divided into cirrhotic (n = 69) and non-cirrhotic (n = 410) groups. Clinical outcomes and survival according to treatment were compared between these groups. Results The cirrhotic group was younger (median age 64 years vs. 69 years, p = 0.022) and had a higher proportion of male (97.1 % vs. 88.3 %, p = 0.042) than the non-cirrhotic group. Patients with cirrhosis were less likely to undergo surgery (31.9 % vs. 47.8 %, p = 0.015) and were more likely to receive no active cancer treatment (26.1 % vs. 13.7 %, p = 0.010). Overall survival was lower in the cirrhotic group (hazard ratio [HR], 1.41; 95 % confidence interval [CI], 1.01-1.99; p = 0.045), however, no difference was found between Child-Pugh class A patients and those in the non-cirrhotic group (HR, 1.04 [95 % CI, 0.69-1.56]; p = 0.864). Postoperative mortality was significantly higher in cirrhotic group (27.3 % vs. 8.7 %, p = 0.011). Upon performing concurrent chemoradiotherapy (CRT), the clinical complete response rate (84.2 % vs. 43.3 %, p = 0.004) was better in the cirrhotic group. CRT yielded better overall survival for patients with cancer in the resectable stages in the cirrhotic group compared to surgery (HR, 0.19 [95 % CI, 0.42-0.84]; p = 0.029]. Conclusions In patient with ESCC and cirrhosis, chemoradiotherapy may be a better treatment option than surgery.
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Affiliation(s)
- Dae Gon Ryu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Mi Sook Yun
- Devision of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hongqun Liu
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Samuel S. Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Sangjune Laurence Lee
- Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
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Toya Y, Hatta W, Shimada T, Matsuhashi T, Shiroki T, Sasaki Y, Tatsuta T, Nakamura J, Hanabata N, Horikawa Y, Nagino K, Koike T, Masamune A, Harada Y, Ohira T, Iijima K, Abe Y, Hikichi T, Igarashi S, Fushimi S, Takeda H, Fukuda S, Matsumoto T. Clinical outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma with esophageal varices: Multicenter retrospective study. Dig Endosc 2024; 36:314-322. [PMID: 37343173 DOI: 10.1111/den.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Clinical outcomes of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) with esophageal varices (EVs) are obscure. We aimed to elucidate the clinical outcomes of ESD for ESCC with EVs in a multicenter, retrospective study. METHODS We established a retrospective cohort of 30 patients with ESCC complicating EVs, who underwent ESD at 11 Japanese institutions. Rates of en bloc resection and R0 resection, procedure time, and adverse events were evaluated as indicators of the feasibility and safety of ESD. Additional treatment, recurrence, and metastasis of the lesions were evaluated as indicators of the long-term efficacy of ESD. RESULTS Portal hypertension was caused by cirrhosis, of which alcohol was the most common cause. En bloc resection was achieved in 93.3% and R0 resection in 80.0% of the patients. The median procedure time was 92 min. Adverse events included a case of uncontrolled intraoperative bleeding leading to discontinuation of ESD and a case of esophageal stricture due to extensive resection. During the follow-up period of a median for 42 months, a patient with local recurrence and another patient with liver metastasis were observed. One patient died of liver failure after receiving chemoradiotherapy as an additional treatment after ESD. No patient died of ESCC. CONCLUSION This multicenter, retrospective cohort study demonstrated the safety and efficacy of ESD for ESCC with EVs. Further studies are needed to establish appropriate treatment methods for EVs before ESD and additional treatments for patients with insufficient ESD.
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Affiliation(s)
- Yosuke Toya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tomohiro Shimada
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takeharu Shiroki
- Department of Gastroenterology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Norihiro Hanabata
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yohei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, Akita, Japan
| | - Ko Nagino
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasuhiko Abe
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shohei Igarashi
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Saki Fushimi
- Department of Gastroenterology, Hiraka General Hospital, Akita, Japan
| | - Hiroaki Takeda
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
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Pai CP, Chien LI, Huang CS, Hsu HS, Hsu PK. Treatment Outcomes and Risk Factors for Incomplete Treatment after Definitive Chemoradiotherapy for Non-Resectable or Metastatic Esophageal Cancer. Cancers (Basel) 2023; 15:5421. [PMID: 38001681 PMCID: PMC10670551 DOI: 10.3390/cancers15225421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Among patients with unresectable or metastatic esophageal cancer who receive definitive chemotherapy or chemoradiotherapy, the rates of treatment-related adverse events and incomplete treatment remain high. We conducted this study to investigate survival after definitive treatments and identify predicting factors for incomplete treatment. The data of patients who received definitive chemotherapy or chemoradiotherapy for esophageal cancer were retrospectively examined. The patients were assigned to Group 1: incomplete definitive treatment; Group 2: complete definitive treatment; or Group 3: complete definitive treatment with additional salvage surgery. The data of 273 patients (90, 166, and 17 in Groups 1, 2, and 3, respectively) were analyzed. In the survival analysis, the median overall survival of Groups 1, 2, and 3 were 2.6, 10.3, and 29.5 months, respectively. A significant difference in 3-year overall survival was observed among the groups (2.2%, 12.4%, and 48.5%, p < 0.001). In multivariable analysis, the independent risk factors for incomplete definitive treatment included poor performance score (hazard ratio (HR): 5.23, p = 0.001), bone metastasis (HR: 2.18, p = 0.024), airway invasion (HR: 2.90, p = 0.001), and liver cirrhosis (HR: 3.20, p = 0.026). Incomplete definitive treatment is associated with a far worse prognosis. Poor performance, bone metastasis, airway invasion, and liver cirrhosis are risk factors for incomplete treatment.
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Affiliation(s)
- Chu-Pin Pai
- Division of Thoracic Surgery, Department of Surgery, Lotung Poh-Ai Hospital, Ilan 26546, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Chien-Sheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Han-Shui Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Po-Kuei Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
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Simonnot M, Deprez PH, Pioche M, Albuisson E, Wallenhorst T, Caillol F, Koch S, Coron E, Archambeaud I, Jacques J, Basile P, Caillo L, Degand T, Lepilliez V, Grandval P, Culetto A, Vanbiervliet G, Camus Duboc M, Gronier O, Leal C, Albouys J, Chevaux JB, Barret M, Schaefer M. Endoscopic resection of early esophageal tumors in patients with cirrhosis or portal hypertension: a multicenter observational study. Endoscopy 2023; 55:785-795. [PMID: 37137331 DOI: 10.1055/a-2085-3964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Liver cirrhosis and esophageal cancer share several risk factors, such as alcohol intake and excess weight. Endoscopic resection is the gold standard treatment for superficial tumors. Portal hypertension and coagulopathy may increase the bleeding risk in these patients. This study aimed to assess the safety and efficacy of endoscopic resection for early esophageal neoplasia in patients with cirrhosis or portal hypertension. METHODS This retrospective multicenter international study included consecutive patients with cirrhosis or portal hypertension who underwent endoscopic resection in the esophagus from January 2005 to March 2021. RESULTS 134 lesions in 112 patients were treated, including by endoscopic submucosal dissection in 101 cases (75 %). Most lesions (128/134, 96 %) were in patients with liver cirrhosis, with esophageal varices in 71 procedures. To prevent bleeding, 7 patients received a transjugular intrahepatic portosystemic shunt, 8 underwent endoscopic band ligation (EBL) before resection, 15 received vasoactive drugs, 8 received platelet transfusion, and 9 underwent EBL during the resection procedure. Rates of complete macroscopic resection, en bloc resection, and curative resection were 92 %, 86 %, and 63 %, respectively. Adverse events included 3 perforations, 8 delayed bleedings, 8 sepsis, 6 cirrhosis decompensations within 30 days, and 22 esophageal strictures; none required surgery. In univariate analysis, cap-assisted endoscopic mucosal resection was associated with delayed bleeding (P = 0.01). CONCLUSIONS In patients with liver cirrhosis or portal hypertension, endoscopic resection of early esophageal neoplasia appeared to be effective and should be considered in expert centers with choice of resection technique, following European Society of Gastrointestinal Endoscopy guidelines to avoid undertreatment.
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Affiliation(s)
- Mathilde Simonnot
- Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
| | - Pierre H Deprez
- Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Mathieu Pioche
- Gastroenterology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Eliane Albuisson
- DRCI, Department MPI, Data management and Statistics UMDS, Nancy Regional University Hospital Center , Nancy, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Stéphane Koch
- Department of Gastroenterology, Besançon Regional University Hospital Center, Besançon, France
| | - Emmanuel Coron
- Institut de Maladies de l'Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France
| | - Isabelle Archambeaud
- Institut de Maladies de l'Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France
| | - Jérémie Jacques
- Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Paul Basile
- Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Rouen, Rouen, France
| | - Ludovic Caillo
- Gastroenterology Department, University Hospital of Nîmes, Nîmes, France
| | - Thibault Degand
- Division of Gastroenterology, Dijon Bourgogne University Hospital, Dijon, France
| | | | - Philippe Grandval
- Hepatogastroenterology Department, AP-HM, Hôpital La Timone, Marseille, France
| | - Adrian Culetto
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | | | | | - Olivier Gronier
- Department of Gastroenterology and Hepatology, Clinique Sainte Barbe, Strasbourg, France
| | - Carina Leal
- Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jérémie Albouys
- Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Jean-Baptiste Chevaux
- Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
| | | | - Marion Schaefer
- Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
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5
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Preoperative Transient Elastography in Patients with Esophageal Cancer. Diagnostics (Basel) 2022; 12:diagnostics12123194. [PMID: 36553201 PMCID: PMC9777419 DOI: 10.3390/diagnostics12123194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Since excessive alcohol consumption is a shared risk factor for esophageal cancer and liver fibrosis, it is possible that patients with esophageal cancer may develop unknown liver fibrosis or cirrhosis. We applied preoperative transient elastography (TE) to patients without recorded cirrhosis undergoing esophagectomy to clarify the validity in predicting postesophagectomy hepatic failure. The cohort consisted of 107 patients who received TE before esophagectomy between June 2018 and December 2021. Patients were categorized into two groups based on the fibrosis score yielded by preoperative TE (mild group: 0~2, n = 92; severe group: 3~4, n = 15). There was no significant difference in demographic data nor surgical variables between the two groups. None of the cohort encountered hepatic failure, yet the severe fibrosis group had a significantly higher rate of pleural effusion (40.0% versus 15.2%, p = 0.03). The areas under the curve (AUCs) of TE in predicting postoperative complications and 180-day mortality were 0.60 (95% CI: 0.46-0.74) and 0.67 (95% CI: 0.51-0.83), respectively. In conclusion, stratification of patients with esophageal cancer who had liver fibrosis by preoperative TE demonstrates significant validity in predicting postoperative pleural effusions. Recruitment of noncirrhotic patients with higher TE scores is warranted to examine its power in other parameters.
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Zhu LL, Liu LX, Wu JC, Gan T, Yang JL. Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis: A propensity score analysis. World J Clin Cases 2022; 10:11325-11337. [PMID: 36387828 PMCID: PMC9649544 DOI: 10.12998/wjcc.v10.i31.11325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND 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.
AIM To evaluate the feasibility, safety, efficacy and long-term survival outcomes of endoscopic submucosal tunnel dissection (ESTD) for treating EESCC in patients with cirrhosis.
METHODS 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.
RESULTS 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).
CONCLUSION 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.
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Affiliation(s)
- Lin-Lin Zhu
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Xia Liu
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jun-Chao Wu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Gan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Xiang Z, Li Y, Zhu C, Hong T, He X, Zhu H, Jiang D. Gastrointestinal Cancers and Liver Cirrhosis: Implications on Treatments and Prognosis. Front Oncol 2021; 11:766069. [PMID: 34746008 PMCID: PMC8567751 DOI: 10.3389/fonc.2021.766069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Liver cirrhosis tends to increase the risk in the management of gastrointestinal tumors. Patients with gastrointestinal cancers and liver cirrhosis often have serious postoperative complications and poor prognosis after surgery. Multiple studies have shown that the stage of gastrointestinal cancers and the grade of cirrhosis can influence surgical options and postoperative complications. The higher the stage of cancer and the poorer the degree of cirrhosis, the less the surgical options and the higher the risk of postoperative complications. Therefore, in the treatment of patients with gastrointestinal cancer and liver cirrhosis, clinicians should comprehensively consider the cancer stage, cirrhosis grade, and possible postoperative complications. This review summarizes the treatment methods of patients with different gastrointestinal cancer complicated with liver cirrhosis.
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Affiliation(s)
- Ze Xiang
- Department of Gastroenterology, Yancheng Third People’s Hospital, Yancheng, China
- School of Medicine, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Yiqi Li
- School of Medicine, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Chaojie Zhu
- School of Medicine, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tu Hong
- School of Medicine, Zhejiang University, Hangzhou, China
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Xianglin He
- Chu Kochen Honors College, Zhejiang University, Hangzhou, China
| | - Hua Zhu
- Department of Gastroenterology, Yancheng Third People’s Hospital, Yancheng, China
| | - Danbin Jiang
- Department of Gastroenterology, Yancheng Third People’s Hospital, Yancheng, China
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Pedunculated esophageal carcinoma endoscopically removed using SB knife Jr with detachable snare after neoadjuvant chemotherapy. Clin J Gastroenterol 2020; 13:1036-1040. [PMID: 32870482 DOI: 10.1007/s12328-020-01214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
An 82-year-old Japanese man with alcoholic liver cirrhosis was referred to our hospital for treatment of advanced esophageal cancer. A protruding tumor was endoscopically observed in the middle thoracic esophagus, and pathological findings of the biopsy specimens revealed a squamous cell carcinoma. The clinical tumor staging was stage II (T3N0M0). The patient received two courses of neoadjuvant chemotherapy with 5-fluorouracil and nedaplatin. After the treatments, computed tomography showed significant reductions in the size of the target tumor. However, radical esophagectomy was not performed because the patient refused major invasive treatments. Instead, endoscopic resection was performed using a combination of polypectomy and endoscopic submucosal resection (ESD). To prevent bleeding during endoscopic treatment, we applied a detachable snare to the base of the tumor and cut the stalk using by an SB knife Jr, without hemorrhage. The pathohistology of the resected specimen was positively showed cancer cells on the margin of the esophageal carcinoma stalk. At 4 weeks after the initial operation, an additional ESD was successfully performed, which pathologically led to radical removal. The patient survived for more than 18 months after beginning the initial treatment. We describe a successful treatment using endoscopic resection after chemotherapy for advanced esophageal cancer with high surgical treatment risks.
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9
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Barrett's adenocarcinoma with esophageal varices successfully treated by endoscopic submucosal dissection with direct varices coagulation. Clin J Gastroenterol 2019; 13:178-181. [PMID: 31559540 DOI: 10.1007/s12328-019-01048-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022]
Abstract
A 67-year-old Japanese man with alcoholic cirrhosis underwent esophagogastroduodenoscopy (EGD), which revealed a 15-mm elevated lesion on the esophagogastric junction (EGJ). Endoscopic findings suggested that the lesion was an intramucosal cancer present on the esophageal varices. The location of the lesion at EGJ caused difficulties in endoscopic injection sclerotherapy and endoscopic variceal ligation for esophageal varices before esophageal endoscopic submucosal dissection (ESD). Direct varices coagulation treatment was therefore selected during ESD. Coagulation of bared varices with hemostatic forceps after mucosal incision enabled performing ESD without serious bleeding. 2 months afterwards, the patient underwent EGD, with no esophageal varices or carcinoma recurrence. Direct varices coagulation was effective for ESD of Barrett adenocarcinoma with esophageal varices.
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10
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Tsou YK, Liu CY, Fu KI, Lin CH, Lee MS, Su MY, Ohata K, Chiu CT. Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis. Dig Dis Sci 2016; 61:3565-3571. [PMID: 27770376 PMCID: PMC5104793 DOI: 10.1007/s10620-016-4342-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/05/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients. AIM To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients. METHODS Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs). RESULTS Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm2, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD. CONCLUSION Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction.
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Affiliation(s)
- Yung-Kuan Tsou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Yuan Liu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Kuang-I Fu
- Department of Gastroenterology, Kanma Memorial Hospital, Nasushiobara, Japan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mu-Shien Lee
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Yao Su
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Valmasoni M, Pierobon ES, De Pasqual CA, Zanchettin G, Moletta L, Salvador R, Costantini M, Ruol A, Merigliano S. Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study. Ann Surg Oncol 2016; 24:763-769. [DOI: 10.1245/s10434-016-5610-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 12/12/2022]
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