Argon plasma coagulation for superficial squamous cell carcinoma in the residual esophagus after esophagectomy
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ORIGINAL ARTICLE
Argon plasma coagulation for superficial squamous cell carcinoma in the residual esophagus after esophagectomy Kohei Saisho1 · Toshiaki Tanaka1 · Satoru Matono1 · Naoki Mori1 · Haruhiro Hino1 · Kazutaka Kadoya1 · Ryosuke Nishida1 · Masahiro Fujisaki1 · Fumihiko Fujita1 · Yoshito Akagi1 Received: 21 November 2019 / Accepted: 18 March 2020 © The Japan Esophageal Society 2020
Abstract Background Patients after esophagectomy for esophageal squamous cell carcinoma (SCC) occasionally develop metachronous SCC in the residual esophagus. Although most of these second primary lesions are detected as superficial cancer at follow-up endoscopy, it is often difficult to perform endoscopic resection for these lesions near the site of anastomosis. Methods The objective of this study was to evaluate the effectiveness of argon plasma coagulation (APC) for superficial SCC in the residual esophagus after esophagectomy. Twelve patients (involving 15 s primary lesions) received APC for superficial SCC in the residual esophagus after esophagectomy. These lesions were difficult to perform endoscopic resection and they were treated using APC. Results There was no treatment-related complication. Complete remission (CR) was achieved in 13 (86.6%) of the 15 lesions: CR was achieved in 11 lesions (73.3%) after the first APC course, and in another 2 lesions (13.3%) after two or more APC courses. Of the 2 patients with persisting residual tumor, 1 patient received 12 times repeated-APC courses over 6 years, and eventually achieved local control without metastasis, the other patient received radiotherapy and cervical esophagectomy after treatment failure with APC. All patients survived except for one patient who died of old age and another patient who died of tongue cancer. Conclusions APC was a safe treatment that was easy to perform. APC was concluded to be an effective treatment for superficial SCC in the residual esophagus after esophagectomy when endoscopic resection was difficult. Keywords Argon plasma coagulation · Esophageal neoplasm · Esophagectomy · Squamous cell carcinoma · Second primary
Introduction Patients after esophagectomy for esophageal squamous cell carcinoma (SCC) occasionally develop metachronous SCC in the residual esophagus [1–3]. SCC in the residual esophagus after esophagectomy is difficult to treat, and there have been few studies of this condition. Most cases are detected as superficial SCC at follow-up endoscopy, and can be completely cured by endoscopic resection [1]. However, it is often difficult to perform endoscopic resection for these lesions if near the site of anastomosis. On the other hand, * Kohei Saisho [email protected]‑u.ac.jp 1
Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume, Fukuoka 830‑0011, Japan
surgical resection for a second primary SCC in the residual esophagus can often lead to a decline in the patient’s quality of life. Argon plasma coagulation (APC) is a noncontact electro-coagulation technique using argon gas for ablation
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