Efficacy and safety of endoscopic submucosal dissection versus endoscopic mucosal resection for superficial esophageal carcinoma: a systematic review and meta-analysis

Summary Endoscopic submucosal dissection (ESD) has been developed to overcome the limitations of endoscopic mucosal resection (EMR). Yet, the potential for EMR should not be ignored. This study aimed to compare the efficacy and safety of ESD and EMR in the treatment of superficial esophageal carcinoma (SEC). All relevant articles were retrieved from electronic databases. The primary outcomes included en bloc resection, curative resection, R0 resection, and local recurrence rates. Secondary outcomes included procedure time, rates of perforation, bleeding, and postoperative stricture. Subgroup analyses based on histologic types and lesion sizes were conducted. Twenty-two studies were enrolled. Overall results showed higher en bloc, curative, and R0 resection rate, and lower recurrence rate in ESD compared with EMR. ESD was significantly more time-consuming and induced more perforations than EMR procedure. In subgroup analyses of squamous cell carcinoma (SCC) and Barrett’s esophagus (BE)-associated neoplasia and esophageal adenocarcinoma (EAC) subtypes, ESD also excelled in en bloc, curative, R0 resection and local recurrence rates. However, in subgroup analysis stratifying outcomes according to lesion sizes, the superior effect of ESD in en bloc resection, curative resection, and local recurrence rate only manifested when lesion size >20 mm. Overall, ESD seemed to have superior efficacy and similar safety profiles compared to EMR in treating SCC, BE-associated neoplasia and EAC. Nevertheless, the selection of ESD or EMR should take lesion size into consideration. EMR is appropriate when lesion size ≤10 mm, EMR and ESD are both applicable for lesion between 11 and 20 mm, and ESD is preferable for lesions >20 mm. More evidences are needed to confirm the current findings.

Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis

Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 23 articles containing data for 4749 patients (range: 54-598) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.85 with 95% confidence interval (CI) (1.10-3.11, P = 0.02). LNM rate was higher in SEC patients with LVI than SEC patients without LVI (univariate: OR = 4.94, 95% CI: 3.74-6.53, P < 0.0001; multivariate: OR = 5.72, 95%CI: 4.38-7.4, P < 0.0001). No obvious publication was found. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC. Keywords: Lymphovascular invasion; lymph node metastasis; prognosis; superficial esophageal carcinoma

Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis

Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 23 articles containing data for 4749 patients (range: 54-598) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.85 with 95% confidence interval (CI) (1.10-3.11, P = 0.02). LNM rate was higher in SEC patients with LVI than SEC patients without LVI (univariate: OR = 4.94, 95% CI: 3.74-6.53, P < 0.0001; multivariate: OR = 5.72, 95%CI: 4.38-7.4, P < 0.0001). No obvious publication was found. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC. Keywords: Lymphovascular invasion; lymph node metastasis; prognosis; superficial esophageal carcinoma

Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis

Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 23 articles containing data for 4749 patients (range: 54-598) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.85 with 95% confidence interval (CI) (1.10-3.11, P = 0.02). LNM rate was higher in SEC patients with LVI than SEC patients without LVI (univariate: OR = 4.94, 95% CI: 3.74-6.53, P < 0.0001; multivariate: OR = 5.72, 95%CI: 4.38-7.4, P < 0.0001). No obvious publication was found. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC.

Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis

Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 28 articles containing data for 5041 patients (range: 29-498) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.62 with 95% confidence interval (CI) (1.17-2.26; p = 0.004) and the odds ratio between LVI and LNM was 5.7 with 95% CI (4.43-7.33; p < 0.0001). LVI in patients diagnosed with SEC results in a poor OS rate and a higher rate of LNM. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC.Keywords: Lymphovascular invasion; lymph node metastasis; prognosis; superficial esophageal carcinoma

Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis

Background:The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear.Methods:We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis.Results:We included 28 articles containing data for 5041 patients (range: 29-498) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.62 with 95% confidence interval (CI) (1.17-2.26; p = 0.004) and the odds ratio between LVI and LNM was 5.7 with 95% CI (4.43-7.33; p < 0.0001). LVI in patients diagnosed with SEC results in a poor OS rate and a higher rate of LNM.Conclusions:The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC.Keywords: Lymphovascular invasion; lymph node metastasis; prognosis; superficial esophageal carcinoma