Clin Endosc.  2023 Jan;56(1):55-64. 10.5946/ce.2022.093.

Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center

• Probst A
• Ebigbo A
• Eser S
• Fleischmann C
• Schaller T
• Märkl B
• Schiele S
• Geissler B
• Müller G
• Messmann H

• KMID: 2538752
• DOI: http://doi.org/10.5946/ce.2022.093

Abstract

Background/Aims
Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center.
Methods
Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database.
Results
R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038).
Conclusions
Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

Keyword

Endoscopic submucosal dissection; Esophageal cancer; Prognosis; Squamous cell cancer

Figure

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  Fig. 1. Endoscopic submucosal dissection procedure of an esophageal squamous cell carcinoma in the proximal esophagus. (A) White light endoscopy. (B) Narrow-band imaging. (C) Resection ulcer after endoscopic submucosal dissection. (D) Histology showing esophageal squamous cell carcinoma restricted to the mucosa (M1) without lymphovascular invasion (absolute indication for endoscopic resection; hematoxylin and eosin stain, ×40).

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  Fig. 2. Patients' inclusion and additional treatment after endoscopic submucosal dissection. ESD, endoscopic submucosal dissection; SM, submucosal invasion; AT, additional treatment.

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  Fig. 3. Kaplan-Meier survival after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. (A) Overall survival for the different groups A, B, C. (B) Disease specific survival for the different groups A, B, C. (C) Overall survival after curative resection versus non-curative resection. (D) Disease specific survival after curative resection versus non-curative resection.

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