Background and Aims
Local recurrence of esophageal squamous cell carcinoma (ESCC) after endoscopic resection
does not have an established treatment. The efficacy and safety of repeat endoscopic
submucosal dissection (ESD) for recurrent ESCC were determined in the study.
Methods
Forty-three consecutive patients with 45 locally recurrent superficial ESCC lesions
undergoing repeat ESD and 909 first ESD lesions for propensity score matching (PSM)
at Zhongshan Hospital between January 2011 and January 2020 were retrospectively enrolled.
After PSM (1:2), operation-related parameters were compared between repeat ESD and
first ESD. In the repeat ESD group, the Kaplan-Meier method and log-rank tests were
used for identification of risk factors for local recurrence after repeat ESD.
Results
As compared with propensity score–matched first ESD, rates of complete resection (86.7%
vs 97.8%, P = .02) and curative resection (86.7% vs 96.7%, P = .06) were lower and procedure duration (54.8 ± 21.7 minutes vs 46.2 ± 20.6 minutes,
P = .67) and hospital stay (4.3 ± 1.8 days vs 2.9 ± 1.4 days, P = .25) were longer in the repeat ESD group. The en-bloc resection rate (93.3% vs
98.8%, P > .11) remained comparable. Adverse events including bleeding (4.4% vs 0%, P = .11), perforation (.0% vs .0%, P > .99), and stricture (6.7% vs 2.2%, P = .33) presented with no difference. The 5-year overall survival rate and recurrence-free
survival rate for repeat ESD was 100% and 86.0%, respectively. Multiplicity was significantly
associated with recurrence after repeat ESD (P = .01).
Conclusions
Repeat esophageal ESD showed favorable short- and long-term outcomes and thus provides
an alternative choice for recurrent superficial ESCC.
Abbreviations:
ESCC (esophageal squamous cell carcinoma), ESD (endoscopic submucosal dissection), LVI (lymphovascular infiltration), PSM (propensity score matching)To read this article in full you will need to make a payment
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References
- Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2021; 71: 209-249
- Oesophageal carcinoma.Lancet. 2013; 381: 400-412
- Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1.Esophagus. 2019; 16: 1-24
- Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma.Am J Gastroenterol. 2013; 108: 544-551
- Efficacy of endoscopic resection and selective chemoradiotherapy for stage I esophageal squamous cell carcinoma.Gastroenterology. 2019; 157: 382-390
- Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial.Ann Surg. 2019; 269: 621-630
- Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis.Therap Adv Gastroenterol. 2020; (:1756284820964316): 13
- Comparison of endoscopic submucosal dissection and surgery for superficial esophageal squamous cell carcinoma: a propensity score-matched analysis.Gastrointest Endosc. 2018; 88: 624-633
- Comparison of the short-term and long-term outcomes of surgical treatment versus endoscopic treatment for early esophageal squamous cell neoplasia larger than 2 cm: a retrospective study.Surg Endosc. 2019; 33: 2304-2312
- A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data.Am J Gastroenterol. 2008; 103: 1340-1345
- Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video).Gastrointest Endosc. 2010; 72: 255-264
- Long-term follow-up after endoscopic resection for superficial esophageal squamous cell carcinoma: a multicenter Western study.Endoscopy. 2019; 51: 298-306
- Outcomes of endoscopic submucosal dissection vs esophagectomy for T1 esophageal squamous cell carcinoma in a real-world cohort.Clin Gastroenterol Hepatol. 2019; 17: 73-81
- Favorable long-term outcomes of endoscopic submucosal dissection for locally recurrent early gastric cancer after endoscopic resection.Endoscopy. 2013; 45: 708-713
- Endoscopic submucosal dissection for residual early gastric cancer after endoscopic submucosal dissection.Gastrointest Endosc. 2013; 77: 298-302
- Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection.Gastric Cancer. 2014; 17: 697-702
- Local recurrence of squamous-cell carcinoma of the esophagus after EMR.Gastrointest Endosc. 2005; 61: 219-225
- Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy.Surg Endosc. 2021; 35: 2229-2239
- Long-term efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing stricture after endoscopic submucosal dissection for esophageal epithelial neoplasms.Surg Endosc. 2019; 33: 1244-1251
- Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis.Gastrointest Endosc. 2017; 86: 831-838
- Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition).Dig Endosc. 2021; 33: 4-20
- Repeated endoscopic submucosal dissection for esophageal neoplasia located close to a previous endoscopic submucosal dissection scar.Clin Transl Gastroenterol. 2020; 11e00226
- Risk factors for postoperative stricture after endoscopic submucosal dissection for superficial esophageal carcinoma.Endoscopy. 2014; 46: 640-644
- Prospective randomized trial comparing the pocket-creation method and conventional method of colorectal endoscopic submucosal dissection.Gastrointest Endosc. 2020; 92: 368-379
- Insulated tip knife tunneling technique with clip line traction for safe endoscopic submucosal dissection of large circumferential esophageal cancer.VideoGIE. 2017; 2: 342-345
- Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial (with video).Gastrointest Endosc. 2020; 91: 55-65
- Metachronous multiple esophageal squamous cell carcinomas and Lugol-voiding lesions after endoscopic mucosal resection.Endoscopy. 2009; 41: 304-309
- Long-term outcome of endoscopic resection for intramucosal esophageal squamous cell cancer: a secondary analysis of the Japan Esophageal Cohort study.Endoscopy. 2020; 52: 967-975
- Lugol chromoendoscopy detects esophageal dysplasia with low levels of sensitivity in a high-risk region of China.Clin Gastroenterol Hepatol. 2018; 16: 1585-1592
- Narrow-band imaging versus Lugol chromoendoscopy for esophageal squamous cell cancer screening in normal endoscopic practice: randomized controlled trial.Endoscopy. 2021; 53: 674-682
- Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin.Cancer. 1953; 6: 963-968
- Recurrence after endoscopic mucosal resection for superficial esophageal cancer.Endoscopy. 2000; 32: 277-280
- Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia.Endoscopy. 2007; 39: 30-35
- Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection.Endoscopy. 2007; 39: 41-45
Article info
Publication history
Published online: February 28, 2022
Accepted:
February 20,
2022
Received:
August 30,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by grants from the National Key R&D Program of China (2019YFC1315800, P.-H. Zhou), National Natural Science Foundation of China (81873552, Q.-L. Li, 82003074, J.-Q. Xu, and 81670483, P.-H. Zhou), Shanghai Rising-Star Program (19QA1401900, Q.-L. Li), Major Project of Shanghai Municipal Science and Technology Committee (18ZR1406700, Q.-L. Li, 19441905200, W.-F. Chen, and 16DZ2280900, L.-Q. Yao), and Shanghai Sailing Program of Shanghai Municipal Science and Technology Committee (2018YF1403700, J.-Q. Xu).
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. One or more of the authors of this paper self-identifies as an under-represented gender minority in science. While citing references scientifically relevant for this work, we actively worked to promote gender balance in our reference list. The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work
If you would like to chat with an author of this article, you may contact Dr Li at [email protected] or Dr Zhou at [email protected]
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© 2022 by the American Society for Gastrointestinal Endoscopy
