老年食管胃双原发癌同期内镜黏膜下剥离术的疗效

doi:10.3969/j.issn.1003-9198.2025.11.014

摘要/Abstract

摘要： 目的评估内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗老年食管胃双原发癌的临床疗效。方法回顾性分析115例同时患有表浅食管癌(superficial esophageal cancer,SEC)和早期胃癌(early gastric cancer,EGC)的老年病人的临床病理资料,评估ESD同期切除食管胃双病变的短期及长期疗效。根据食管和胃部病变是否均达到ESD治愈性切除,将病人分为治愈性切除组和非治愈性切除组,分析比较2组的预后。结果 115例老年食管胃双原发癌病人中双病变整体的整块切除率、完全切除率和治愈性切除率分别为100%(115/115)、93.9%(108/115)和72.2%(83/115)。11例(9.6%)病人出现并发症,包括7例出血和4例食管狭窄。中位随访时间为53个月,3例(2.6%)病人发生远处转移,出现同时性癌和异时性癌的病人分别有 5例(4.3%)和 15例(13.0%),无局部复发病人。病人总生存率为87.8%(101/115),疾病特异性生存率为97.4%(112/115)。治愈性切除组的异时性癌(7.2%比28.1%)及远处转移(0比9.4%)发生率均低于非治愈性切除组,且总生存率(92.8%比75.0%)及疾病特异性生存率(100%比93.7%)均显著升高(P＜0.05)。结论 ESD可能是老年食管胃双原发癌病人一种安全有效的治疗手段。食管胃双病变均达治愈性切除的病人预后更好,但术后需长期内镜监测。

关键词: 内镜黏膜下剥离术, 表浅食管癌, 早期胃癌, 老年人, 疗效

Abstract: Objective To assess the clinical efficacy of endoscopic submucosal dissection (ESD) for double primary cancers of the esophagus and stomach in the elderly patients. Methods The clinicopathological data of 115 elderly patients with both superficial esophageal cancer (SEC) and early gastric cancer (EGC) were retrospectively analyzed to evaluate the short- and long-term efficacy of simultaneous resection by ESD. The patients were divided into curative resection group and non-curative resection group according to whether both esophageal and gastric lesions achieved curative resection by ESD, and the prognosis of the two groups was compared. Results The en bloc resection rate, complete resection rate and curative resection rate of the double lesions in 115 elderly patients was 100% (115/115), 93.9% (108/115) and 72.2% (83/115), respectively. Complications were observed in 11 patients (9.6%), including 7 cases of bleeding and 4 cases of esophageal stenosis. During a median follow-up time of 53 months, distant metastases occurred in 3 (2.6%) patients, and simultaneous and metachronous cancers developed in 5 (4.3%) and 15 (13.0%) patients, respectively, and there were no patients with local recurrence. The overall survival rate was 87.8% (101/115), and the disease-specific survival rate was 97.4%(112/115). The incidence of metachronous cancers (7.2% vs 28.1%) and distant metastasis (0 vs 9.4%) was lower, and the overall survival rate (92.8% vs 75.0%) and disease-specific survival rate (100% vs 93.7%) were both significantly higher in the curative resection group than those in the non-curative resection group (P＜0.05). Conclusions ESD may be a safe and effective treatment method for elderly patients with double primary cancers of the esophagus and stomach. The patients with curative resection of esophagogastric lesions have a better prognosis, but long-term postoperative endoscopic surveillance is needed.

Key words: endoscopic submucosal dissection, superficial esophageal cancer, early gastric cancer, aged, efficacy

中图分类号:

吴海, 毛尚焘, 项英, 马艺淳, 潘银雅, 李文君, 徐桂芳. 老年食管胃双原发癌同期内镜黏膜下剥离术的疗效[J]. 实用老年医学, 2025, 39(11): 1140-1144.

WU Hai, MAO Shangtao, XIANG Ying, MA Yichun, PAN Yinya, LI Wenjun, XU Guifang. Efficacy of simultaneous endoscopic submucosal dissection for double primary cancers of the esophagus and stomach in elderly[J]. Practical Geriatrics, 2025, 39(11): 1140-1144.

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