Favorable Long-Term Outcomes With ESD for Esophageal Squamous Cell Cancer

Prateek Sharma, MD, FASGE, reviewing Minamide T, et al. Gastrointest Endosc 2022 Oct 10.

Endoscopic resection is a minimally invasive and curative treatment option for those with superficial esophageal squamous cell carcinoma (ESCC). Endoscopic submucosal dissection (ESD), although more difficult to perform, has become more widely used than the traditionally used endoscopic mucosal resection. 

This single-center retrospective study included 52 patients with circumferential ESCC (median age, 72.5 years; 90.4% men) who had lesions primarily in the middle esophagus (53.8%) with a median tumor length of 5.0 cm (interquartile range, 4.0-6.3 cm). Thirty-one patients had low-risk ESCC (pT1a, no lymphovascular invasion, and negative vertical margin), and 21 patients were considered high risk. 

En bloc resection was attained for all patients, and R0 resection was achieved in 36 participants (69.2%; 95% confidence interval [CI], 54.9-81.3). Patients were followed for a mean of 49.1 months. Forty-two patients who underwent only ESD treatment had a 4-year overall survival rate of 86.2% (95% CI, 71.6-93.6), a disease-specific survival rate of 95.5% (95% CI, 83.1-98.9), and a cumulative recurrence rate of 11.5% (95% CI, 4.1-23.1). Complications included esophageal strictures (86%), intraprocedural perforations (8%), and delayed bleeding (2%). No statistically significant difference was shown in overall survival between low-risk and high-risk participants.

Prateek Sharma, MD, FASGE

COMMENT

At 4 years of follow-up, ESD has favorable outcomes in patients with circumferential ESCC. Stricture rates are high, which indicates the need to address strictures during patient follow-up and management.

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)

Minamide T, Kawata N, Maeda Y, et al. Clinical outcomes of endoscopic submucosal dissection for superficial circumferential esophageal squamous cell carcinoma. Gastrointest Endosc 2022 Oct 10. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.09.027)

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