Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
- Cancers autres (hors CCR et CHC)
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
  2015 Sep;47(9):775-83  
  doi: 10.1055/s-0034-1391844  
  Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study  
  Tsujii Y, Nishida T, Nishiyama O, Yamamoto K, Kawai N, Yamaguchi S, Yamada T, Yoshio T, Kitamura S, Nakamura T, Nishihara A, Ogiyama H, Nakahara M, Komori M, Kato M, Hayashi Y, Shinzaki S, Iijima H, Michida T, Tsujii M, Takehara T  


The safety and efficacy of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs) have not been evaluated in a multicenter survey. The aim of this study was to investigate the clinical outcomes in a multicenter study that included municipal hospitals.


Of 312 consecutive patients with 373 esophageal lesions treated by ESD at 11 hospitals from May 2005 to December 2012, a total of 368 SENs in 307 patients were retrospectively analyzed.


The median tumor size was 18 mm (range 2 - 85 mm). The median procedure time was 90 minutes (range 12 - 450 minutes). The en bloc resection and complete resection rates were 96.7 % (95 % confidence interval [CI] 94.4 % - 98.1 %) and 84.5 % (95 %CI 80.5 % - 87.8 %), respectively. Perforation (including mediastinal emphysema), postoperative pneumonia, bleeding, and esophageal stricture, occurred in 5.2 % (95 %CI 3.3 % - 7.9 %), 1.6 % (95 %CI 0.7 % - 3.5 %), 0 %, and 7.1 % (95 %CI 4.9 % - 10.2 %) of patients, respectively. All of these complications were cured conservatively. No procedure-related mortality occurred. Early treatment periods (odds ratio [OR] = 4.04; P < 0.01) and low volume institutions (OR = 3.03; P  = 0.045) were significantly independent risk factors for perforation. The circumference of the lesion was significantly associated with postoperative stricture (OR = 32.3; P < 0.01). The procedure times significantly decreased in the later period of the study (P < 0.01). Follow-up data (median 35 months; range 4 - 98 months) showed significant differences in overall survival (P = 0.03) and recurrence-free survival (P < 0.01) rates between patients with curative and noncurative resections.


Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

Question posée
La résection des cancers superficiels de l’œsophage par dissection sous-muqueuse est-elle sûre et efficace ?
Question posée
Étude rétrospective multicentrique sur 368 lésions chez 307 patients. Résection monobloc dans 96,7% des cas et résection complète dans 84,5% des cas. Les complications type perforation, pneumopathie, sténose œsophagienne survenaient dans respectivement 5,2%, 1,6%, et 26% des cas. La survenue de récurrence locale et ou métastases étaient observées chez 1,9% des patients en résection curative et 9,4% des patients n’ayant pas eu de résection curative.

La résection complète en monobloc des cancers superficiels de l’œsophage  par dissection sous-muqueuse réalisée par une équipe entraînée donne de bons résultats carcinologiques et s’installe comme l’un des traitements de référence de ces lésions, comme le suggèrent les recommandations européennes.