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Clinical outcomes of endoscopic submucosal dissection for superficial circumferential esophageal squamous cell carcinoma

Published:October 10, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.027
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      ABSTRACT

      Background and Aims

      To elucidate the clinical outcomes of endoscopic submucosal dissection (ESD) for superficial circumferential esophageal squamous cell carcinoma (cESCC).

      Methods

      Consecutive patients who underwent ESD for cESCC between 2009 and 2020 were retrospectively reviewed. Short-term outcomes included en bloc resection, R0 resection, procedure time, and adverse events. Long-term outcomes included overall survival (OS), disease-specific survival (DSS), cumulative recurrence rate (CRR), and clinical course.

      Results

      A total of 52 patients with 52 cESCCs (median tumor length, 5.0 cm; interquartile range [IQR], 4.0–6.3 cm) were evaluated. The en bloc resection and R0 resection rates were 100% (95% confidence interval [CI], 94.4–100) and 69.2% (95% CI, 54.9–81.3), respectively. The median procedure time was 112 min (IQR, 87–162 min). Intraoperative perforations and delayed bleeding occurred in 4 (7.7%) and 1 (1.9%) patients, respectively. Among the 42 patients who underwent ESD alone, 36 (85.7%) experienced esophageal strictures. Within a median follow-up period of 49.1 months (IQR, 25.7–74.7 months), the 4-year OS, DSS, and CRR were 86.2% (95% CI, 71.6–93.6), 95.5% (95% CI, 83.1–98.9), and 11.5% (95% CI, 4.1–23.1), respectively. There was no significant difference in the OS between patients with low-risk cESCC (pT1a, negative lymphovascular invasion, and negative vertical margin) and high-risk lesions, regardless of undergoing additional treatment (P = 0.93). In 31 patients with low-risk cESCC who were treated with ESD alone, the 4-year OS, DSS, and CRR were 93.2%, 100%, and 0%, respectively.

      Conclusions

      ESD is a highly curative treatment for cESCC with favorable long-term outcomes, especially in low-risk patients. Stricture-prevention techniques should be improved to optimize the benefits of ESD for cESCC.

      Graphical abstract

      Keywords

      Acronyms and abbreviations:

      CCI (Charlson Comorbidity Index), cESCC (circumferential esophageal squamous cell carcinoma), CI (confidence interval), CRR (cumulative recurrence rate), CRT (chemoradiotherapy), CT (computed tomography), DSS (disease-specific survival), ECOG (Eastern Cooperative Oncology Group), EMR (endoscopic mucosal resection), EP (epithelium), ESCC (esophageal squamous cell carcinoma), ESD (endoscopic submucosal dissection), HM (horizontal margin), IQR (interquartile range), LNM (lymph node metastasis), LPM (lamina propria mucosa), LVI (lymphovascular invasion), MM (muscularis mucosa), OS (overall survival), RT (radiotherapy), SM1 (submucosal layer ≤200 μm), SM2 (submucosal layer >200 μm), VM (vertical margin), VM0 (negative vertical margin), VM1 (positive vertical margin), VMX (unclear vertical margin)
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