Endoscopic Submucosal Dissection (ESD) ameliorates T-lymphocyte imbalance and inflammatory cytokines in early GI cancer

Patients with early gastrointestinal cancer often present with systemic inflammation and altered immune responses, characterized by imbalances in T-lymphocyte subsets and elevated inflammatory cytokines. These immune-inflammatory markers are increasingly recognized as crucial prognostic indicators, influencing disease progression and postoperative outcomes. Current surgical interventions, while effective for tumor removal, can themselves induce inflammatory responses. Understanding the dynamic changes in these immune parameters following minimally invasive procedures like Endoscopic Submucosal Dissection (ESD) is vital to optimize treatment strategies and predict patient recovery, especially given the technique's ability to achieve en bloc resection for lesions untreatable by conventional methods.

This prospective cohort study enrolled a total of 189 patients diagnosed with early gastrointestinal cancer who underwent Endoscopic Submucical Dissection (ESD) and achieved en bloc resection. The cohort included 53 cases of early esophageal cancer, 55 cases of early gastric cancer, and 81 cases of early colorectal cancer. Patients were categorized into three groups based on resection completeness: a non-R0 en bloc resection group (n=32), a non-curative R0 resection group (n=62), and a curative resection group (n=95). Researchers analyzed clinical characteristics, T-lymphocyte subsets (e.g., CD4+, CD8+), inflammatory markers (e.g., CRP, IL-6, TNF-α), and postoperative complications at pre-ESD, and on postoperative days 1, 7, and 30.

Endoscopic Submucosal Dissection (ESD) led to a significant amelioration of both T-lymphocyte subsets and inflammatory cytokine levels in patients with early gastrointestinal cancer. The most pronounced improvement in these immune and inflammatory indices was consistently observed in the curative resection group, highlighting the therapeutic benefits of complete tumor removal. Pre- and post-ESD levels of these markers demonstrated strong and significant correlations with key tumor characteristics, including lesion size, tumor morphology, and depth of invasion. This suggests that the extent of the tumor burden directly impacts the systemic inflammatory and immune response. Notably, the non-R0 en bloc resection group experienced a markedly higher postoperative complication rate compared to the other groups, while the curative resection group exhibited the lowest rate, reinforcing the importance of complete resection for patient safety. > Improvements in immune and inflammatory indicators after ESD did not differ significantly among early cancers originating from different gastrointestinal sites, indicating a generalized systemic effect of the procedure. The incidence of postoperative complications was also not associated with the specific tumor site.