浅表性食管腺癌的新方法:转向更个性化的治疗

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY
E.P.D. Verheij , S.N. van Munster , J.J.G.H.M. Bergman , R.E. Pouw
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引用次数: 0

摘要

浅表性食管腺癌(EAC)的发病率正在上升,值得关注。淋巴结清扫的侵入性手术是EAC长期以来的标准治疗方法。然而,内镜下切除技术,如基于帽的内镜下切除术或内镜下黏膜下剥离术(ESD),已被证明是去除浅表EAC的安全有效的替代方案。因此,内镜下切除术现在是治疗浅表性EAC的基石,无论是诊断还是治疗。目前的指南建议对小而平坦的病变使用基于盖帽的方法,而对大而笨重的病变、疑似黏膜下浸润的病变或疤痕区域的病变则建议使用ESD。切除后的组织病理学评估,评估淋巴结转移的组织学风险因素,在决定是否需要额外手术中起着关键作用。直到最近,所有粘膜下和/或高危EAC都有额外(预防性)手术的指征,因为假设淋巴结转移的风险很高。然而,这种风险似乎比最初假设的要低,低风险黏膜下EAC的内镜治疗正在获得认可。正在进行的前瞻性试验将有助于确定粘膜下和/或高危EAC患者的警惕等待策略是否可以替代手术。在未来,可以安全地遵循警惕等待策略的患者和可能从额外手术中受益的患者之间的区别可能会变得更加明确,从而为浅表性EAC患者提供更优化的患者定制管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Advancing Approaches for Superficial Esophageal Adenocarcinoma: Shifting Toward More Patient-tailored Therapy

The incidence of superficial esophageal adenocarcinoma (EAC) is rising and warrants awareness. Invasive surgery with lymph node dissection was long standard treatment for EAC. However, endoscopic resection techniques, such as cap-based endoscopic resection or endoscopic submucosal dissection (ESD), have proven to be safe and effective alternatives for removal of superficial EAC. Therefore, endoscopic resection is now the cornerstone of management for superficial EAC, for both diagnostic and therapeutic purposes. Current guidelines advise use of the cap-based approach for small, flat lesions, whereas ESD is recommended for large and bulky lesions, lesions with suspected submucosal invasion, or lesions in scarred areas. The histopathological assessment after a resection, evaluating histological risk factors for lymph node metastases, plays a key role in the decision about whether additional surgery is indicated. Until recently, all submucosal and/or high-risk EAC had an indication for additional (prophylactic) surgery because of the assumed high risk for lymph node metastases. However, this risk appears lower than initially assumed, and endoscopic management for low-risk submucosal EAC is gaining acceptance. Ongoing prospective trials will help to determine whether a watchful waiting strategy could be an alternative to surgery in patients with submucosal and/or high-risk EAC. In the future, the distinction between patients who can safely be followed with a watchful waiting strategy and patients who might benefit from additional surgery could become more unambiguous, resulting in more optimal patient-tailored management for patients with superficial EAC.

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来源期刊
CiteScore
2.10
自引率
50.00%
发文量
60
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