Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11325-11337
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11325
Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis: A propensity score analysis
Lin-Lin Zhu, Li-Xia Liu, Jun-Chao Wu, Tao Gan, Jin-Lin Yang
Lin-Lin Zhu, Li-Xia Liu, Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Lin-Lin Zhu, Jun-Chao Wu, Tao Gan, Jin-Lin Yang, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yang JL and Gan T designed the research; Gan T, Yang JL and Wu JC performed the endoscopic submucosal tunnel dissection; Zhu LL performed the follow-ups and data collection; Liu LX and Zhu LL analyzed the data; Zhu LL wrote the paper.
Supported by the Sichuan Science and Technology Program, No. 22GJHZ0177 and No. 2019YJ0102.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University (Approval No. 201581).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix and dataset available from the corresponding author at reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Lin Yang, MD, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 GuoXueXiang St, Chengdu 610041, Sichuan Province, China. mouse-577@163.com
Received: June 24, 2022
Peer-review started: June 24, 2022
First decision: September 2, 2022
Revised: September 13, 2022
Accepted: September 27, 2022
Article in press: September 27, 2022
Published online: November 6, 2022
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.

Keywords: Endoscopic submucosal tunnel dissection, Early esophageal cancer, Liver cirrhosis, Gastroesophageal varices, Survival, Propensity score matching

Core Tip: Endoscopic submucosal tunnel dissection (ESTD) is a modification of traditional endoscopic submucosal dissection that provides a clear visual field and sufficient operative space through the submucosal tunnel. In the present cohort study, we found that ESTD can be safely performed in patients with early esophageal squamous cell carcinoma (EESCC) and cirrhosis without increasing the risk of intraoperative and postoperative bleeding. In addition, the disease-specific survival and recurrence-free survival of cirrhosis patients were comparable to those of general patients. Finally, we also found that EESCC patients with Child-Pugh A disease seem to be good candidates for ESTD.