Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma Invading the Muscularis Mucosae Without Lymphovascular Invasion

Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma Invading the Muscularis Mucosae Without Lymphovascular Invasion

Prateek Sharma, MD, FASGE, reviewing Sato D, et al. Gastrointest Endosc 2021 Nov 10.

Superficial esophageal squamous cell carcinoma (ESCC) involving the epithelium and lamina propria is treated with endoscopic resection (ER) due to negligible risk of lymph node metastasis. ESCC invading the muscularis mucosae without evidence of lymphovascular invasion (LVI) can also be treated solely with ER; however, long-term recurrence rates are not clear.   

This single-center, retrospective cohort study included 87 patients (76 males; median age, 68 years) with early ESCC (without lymph node/distant metastasis, no LVI) treated with en bloc resection by ER and no additional treatment after endoscopy. ESD was the ER modality in 74 patients and EMR in 13 patients. The median tumor size was 24.0 mm (3-164 mm). The majority of tumors were moderately differentiated by histology (83.9%), whereas the remaining were poorly differentiated (14.9%) or well-differentiated (1.2%). The horizontal margin was positive in 22 patients (25.3%) and unknown in 5 (5.7%).  

The mean follow-up was 61 months (range, 12-117 months), during which 3 patients (3.4%) had lymph node recurrence and/or distant metastasis. All 3 patients received systemic chemotherapy or chemoradiotherapy; however, all 3 died of primary ESCC. The 5-year cumulative recurrence rate was 4.3%, and the 5-year recurrence-free, disease-specific, and overall survival rates were 88.8%, 98.2%, and 91.7%, respectively.

Prateek Sharma, MD, FASGE

COMMENT

Although the recurrence rate of early-stage ESCC (invasion of muscularis mucosae) without evidence of lymphovascular invasion or distant organ metastasis treated solely with ER is very low (<5%), recurrences even beyond 3 years can occur. Long-term surveillance after ER is recommended in this patient population.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Sato D, Kadota T, Inaba A, et al. Long-term clinical outcome after endoscopic resection of esophageal squamous cell carcinoma invading the muscularis mucosae without lymphovascular invasion. Gastrointest Endosc 2021 Nov 10. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.11.001)

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