Extensive (8 to 12 cm2) noncircumferential endoscopic mucosal resection for early esophageal cancer.

Détails

ID Serval
serval:BIB_E6BDC7B19570
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Extensive (8 to 12 cm2) noncircumferential endoscopic mucosal resection for early esophageal cancer.
Périodique
Annals of Thoracic Surgery
Auteur(s)
Monnier Philippe, Jaquet Yves, Radu Alexandre, Pilloud Raphaelle, Grosjean Pierre, Escher Anette, Piotet Elsa, Blant Snezana Andrejevic
ISSN
1552-6259[electronic], 0003-4975[linking]
Statut éditorial
Publié
Date de publication
2010
Volume
89
Numéro
6
Pages
2151-2155
Langue
anglais
Résumé
Background: Endoscopic mucosal resection (EMR) is an appealing method for treating intramucosal esophageal cancer but must comply with the following stringent requirements: proper preoperative staging, complete resection of the lesion, obtaining a resected specimen for histologic analysis of safety margins, and squamous reepithelialization without stricture formation.
Methods: A rigid esophagoscope was created to resect up to 12 cm(2) of esophageal mucosa in a single specimen and at a constant depth through the submucosa. Under visual control, the esophageal mucosa is sucked into a transparent window and resected with a thin diathermy wire loop in 10 seconds. After extensive preclinical studies in a sheep model, this article reports our early experience in humans.
Results: Twenty-one hemi-circumferential EMRs were performed for 11 dysplastic Barrett's esophagi and 10 early squamous cell carcinomas with no perforation, one hemorrhage controlled by embolization of the left gastric artery, and one incomplete resection. Deep safety margins were clear in 19 of 21 resected specimens (2 patients, unfit for operations, had submucosal invasion of squamous cell carcinoma and adenocarcinoma, respectively). Lateral margins were not clear by definition in 7 circumferential Barrett's esophagi, but were clear in 4 incomplete Barrett's esophagi and 10 early squamous cell carcinomas.
Conclusions: Large EMRs of 12 cm(2) can safely be performed at the submucosal level in the esophagus. Although feasible in one session, circumferential EMR in humans is not yet advisable because of the risk of stricture formation during the healing phase. The rate of complications of this series of 21 EMRs in humans is acceptable. (Ann Thorac Surg 2010; 89: S2151-5) (C) 2010 by The Society of Thoracic Surgeons
Mots-clé
High-Grade Dysplasia, Barretts-Esophagus, Photodynamic Therapy, Early Adenocarcinoma, Circumferential Emr, Focal Ablation, Carcinoma, Epithelium, Destruction, Neoplasia
Pubmed
Web of science
Création de la notice
08/06/2010 15:44
Dernière modification de la notice
20/08/2019 16:09
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