Even though the conventional treatment for T1 esophageal cancer is surgery, ESD is becoming the primary treatment. Currently, it is unknown whether secondary esophagectomy after endoscopic submucosal dissection (ESD) is comparable to primary esophagectomy when considering outcomes in patients with T1 esophageal cancer. We compared short- and long-term clinical outcomes between the two groups. Primary surgery (esophagectomy) was performed in 191 patients between 2003 and 2014, and 62 patients underwent secondary surgery (esophagectomy) after ESD for T1 esophageal cancer between 2007 and 2019. Propensity matching was performed for age, sex, Charlson Comorbidity Index (CCI), location, pathology, degree of differentiation, tumor size, and invasion depth. Lymph node metastasis (LNM), overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and post-operative complications were compared between groups. Sixty-eight patients were included after propensity score matching; LNM, OS, DSS, and RFS were comparable between the two groups. Comparing primary and secondary surgery, the respective LNM rates were 23.5% and 26.5%, 6-year OS 78.0% and 89.7%,p= 0.15; DSS were 80.4% and 96.8%,p= 0.057; and RFS were 80.8% and 89.7%,p= 0.069. Comparing the adverse events between the two groups, there was no significant difference in the overall adverse events. However, more early complications were observed in the primary surgery group than in the secondary surgery group (50% vs. 20.6%,p= 0.021). Secondary surgery did not increase the risk of LNM. The long-term outcomes were comparable. Therefore, attempts to perform upfront ESD for superficial esophageal squamous cell cancers are justified.
尽管T1期食管癌的传统治疗方式是手术，但内镜黏膜下剥离术（ESD）正逐渐成为主要治疗方法。目前，对于T1期食管癌患者，内镜黏膜下剥离术后进行的二次食管切除术与初次食管切除术在治疗效果上是否相当尚不明确。本研究比较了两组患者的短期与长期临床结局。2003年至2014年间，191例患者接受了初次手术（食管切除术）；2007年至2019年间，62例T1期食管癌患者在ESD后接受了二次手术（食管切除术）。研究通过倾向性匹配平衡了年龄、性别、查尔森合并症指数（CCI）、肿瘤位置、病理类型、分化程度、肿瘤大小及浸润深度等因素。比较两组间的淋巴结转移率（LNM）、总生存期（OS）、疾病特异性生存期（DSS）、无复发生存期（RFS）及术后并发症情况。经倾向评分匹配后共纳入68例患者，结果显示两组在LNM、OS、DSS和RFS方面均无显著差异。具体数据对比显示：初次手术与二次手术组的LNM率分别为23.5%和26.5%；6年OS率为78.0%对比89.7%（p=0.15）；DSS率为80.4%对比96.8%（p=0.057）；RFS率为80.8%对比89.7%（p=0.069）。在不良事件方面，两组总体并发症发生率无显著差异，但初次手术组早期并发症发生率高于二次手术组（50%对比20.6%，p=0.021）。研究表明，二次手术并未增加淋巴结转移风险，长期疗效与初次手术相当。因此，对浅表性食管鳞状细胞癌优先尝试ESD治疗具有合理性。
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