优化早期食道腺癌的管理:多学科计划的纵向结果
Uzair M Jogiat1,2, Hillary Wilson3, Alexandre Bédard4
1Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada. ujogiat@ualberta.ca.
Surgical endoscopy
|July 11, 2023
概括
与手术相比,早期食道癌的内镜切除显示出类似的整体存活率,但无复发性存活率更差. 高度疾病和下膜入侵预测需要食道切除术.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 在瘤学瘤学.
背景情况:
- 早期食道癌的治疗需要仔细考虑治疗选择.
- 多学科的方法对于优化患者选择内镜切除与手术的选择至关重要.
- 这些治疗方式的长期结果需要彻底检查.
研究的目的:
- 为了比较患者的长期结果,特别是整体存活率 (OS) 和无复发性存活率 (RFS),患有早期食道癌的患者接受了内镜切除治疗与食道切除术.
- 为了确定在初始内镜切除后接受食道切除术的预测因素.
主要方法:
- 对111名患有早期食道癌的患者进行了回顾性分析.
- 收集的数据包括人口统计,并发症,病理学,OS和RFS.
- 统计分析包括卡普兰-梅尔,日志等级测试,多变量考克斯和后勤回归模型.
主要成果:
- 在手术 (67.0个月) 和内镜切除 (74.0个月) 组 (p=0.93) 之间,中位 OS 是可比的 (p=0.93).
- 与手术组 (109.4个月) 相比,内镜切除组 (63.3个月) 的中位数RFS明显更差 (p=0.0127).
- 多变量分析显示,内切除与食道切除的RFS明显较差 (HR2.55) 但相当于内切除与食道切除的OS. 高度疾病和下膜干扰预测需要食道切除术.
结论:
- 多学科的方法确保了早期食道癌的优秀RFS和OS.
- 粘膜下部的参与和高度疾病增加了局部复发的风险,这表明在这些情况下要仔细考虑内镜切除.
- 增强的风险分层模型可以优化患者选择和食道癌治疗的长期结果.
更多相关视频
相关概念视频
Barrett Esophagus-II: Clinical Manifestations and Management
213
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
213
Esophageal Varices-II: Clinical Features and Management
99
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
99
Esophageal Strictures-II: Clinical Features and Management
107
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
107
Barrett Esophagus-I: Introduction
133
Barrett's esophagus is a medical condition where the esophageal mucosa is significantly damaged by stomach acid or other digestive fluids, often due to long-term exposure associated with gastroesophageal reflux disease (GERD). In GERD, a weakened or abnormally relaxed lower esophageal sphincter allows stomach acid to flow persistently into the esophagus.
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
133
Gastroesophageal Reflux Disease II: Clinical Features and Management
116
Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
116
Esophageal Perforation-II: Clinical Manifestations and Management
90
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
90


