Résumé
Introduction
La résection muqueuse endoscopique (EMR) est un traitement curatif des cancers épidermoïdes (SCC) superficiels de l’œsophage. L’objectif de cette étude était d’évaluer l’évolution à long terme et la survie des patients traités par EMR.
Patients et méthodes
Quarante-quatre patients ont été traités par EMR entre février 1998 et octobre 2005 pour 49 SCC superficiels de l’œsophage. Chaque patient avait une échoendoscopie avant l’EMR. La technique utilisée était l’aspiration-section, la traction-section ou une combinaison des deux techniques.
Résultats
Tous les patients étaient T1N0 en échoendoscopie standard. Aucune complication majeure de l’EMR n’est survenue. Le suivi médian après le geste était de 44 mois. Un traitement curatif a été possible dans 68 % des cas (patients classés T1m1, T1m2), et aucun n’a présenté de récidive. Parmi les patients traités pour une lésion T2 (huit patients), six ont eu une radiochimiothérapie complémentaire et un est décédé des suites d’une évolution métastatique d’un cancer de l’œsophage. Les deux autres patients ont eu une chirurgie complémentaire à type d’oesophagectomie, et un d’entre eux est décédé suite à une récidive métastatique du cancer de l’œsophage. Huit patients avaient une lésion infiltrante en profondeur et présentant donc un risque potentiel d’envahissement ganglionnaire (deux T1m3, trois T1sm1, deux T1sm2 et un T1sm3). Parmi ces patients, six ont une radiochimiothérapie complémentaire et deux ont simplement été surveillés, aucun de ces patients n’a eu de récidive à long terme.
Conclusion
Le SCC superficiel de l’œsophage classé usT1N0 en échoendoscopie standard peut être traité curativement par une EMR avec un taux de résécabilité élevé (98 %) et un taux acceptable de complications. Dans le sous-groupe des 12 patients ayant une lésion plus infiltrante (m3 sm1, sm2, sm3 et T2) et traités par radiochimiothérapie complémentaire, la survie globale (SG) à cinq ans est excellente (91 %).
Abstract
Introduction
Endoscopic mucosal resection (EMR) is a curative treatment of early squamous cell carcinoma (SCC) of the esophagus. The objective was to evaluate the efficacy, safety, long-term outcome, and survival of EMR.
Patients and methods
Forty-four patients were treated by EMR between February 1998 and October 2005 for an early SCC of the esophagus. The technique of EMR was carried out by suction and section with cap or traction and section, or by the combination of both.
Results
Forty-four patients had endoscopic treatment with resection of 49 early SCC. They were all of T1N0 stage as found by standard endoscopic ultrasound (EUS). No major complications occurred. The median endoscopic follow-up was 44 months. A curative resection (T1m1, T1m2) was achieved in 68% of cases without recurrence. Among patients with T2 lesion (16%), 6 had a radio-chemotherapy and only 1 patient died because of the metastatic evolution of esophageal cancer. The remaining 2 left patients had a complementary esophagectomy, among whom 1 died after recurrence. Eight patients had a histologically significant risk of nodes invasion (2 m3, 3 sm1, 2 sm2, and 1 sm3), and 6 had a complementary radio-chemotherapy without recurrence in the follow-up.
Conclusion
SCC of the esophagus shown usT1N0 in EUS can be treated curatively by endoscopic mucosal resection with a high rate of resecability (98%) and an acceptable complication rate. In the subgroup of 12 patients (m3 sm1, sm2, sm3 and T2) that were treated by complementary radiochemotherapy, the 5-year overall survival was 91%.
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Canard, J.M., Rahmi, G., Palazzo, L. et al. Évolution favorable à long terme des patients traités par résection muqueuse endoscopique pour une dysplasie de haut grade ou un cancer épidermoïde superficiel de l’œsophage. Acta Endosc 41, 193–199 (2011). https://doi.org/10.1007/s10190-011-0174-8
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DOI: https://doi.org/10.1007/s10190-011-0174-8