Clinical Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Neoplasms: A Retrospective Single-Center Study in China

Abstract

Aims. To retrospectively analyze the clinical outcomes for a large number of endoscopic submucosal dissections (ESDs) in early esophageal squamous cell neoplasms (ESCNs) at the First Affiliated Hospital of Nanjing Medical University. Patients and Methods. From January 2010 to February 2014, 296 patients (mean age 61.4 years, range 31–85 years; 202 men) with 307 early ESCNs (79 intramucosal invasive esophageal squamous cell carcinomas (ESCCs) and 228 high-grade intraepithelial neoplasia (HGIN) cases) were included from a total of 519 consecutive patients who were treated by esophageal ESD at our hospital. The primary end points of the study were rates of en bloc resection and complete resection. Secondary end points were complications, residual and recurrence rates, and mortality during follow-up. Results. The en bloc resection rate and complete resection rate were 93.5% and 78.2%, respectively. Complications included strictures (8.4%), perforations (1.0%), and bleedings (0.7%). Twenty-seven (9.1%) patients experienced residual and 18 (6.1%) patients experienced recurrence during a mean follow-up period of 30 months. Thirteen patients died from causes unrelated to ESCC, and no cancer-related death was observed. Conclusions. Our study showed that ESD is a successful and relatively safe treatment for intramucosal invasive ESCC and HGIN, fulfilling the criteria of lymph node negative tumors. This should encourage clinicians to select ESD performed by experienced operators as a potential or even preferred treatment option for lesions amenable to endoscopic treatment.

Does a history of head and neck cancer affect outcome of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma?

“…Our results suggest that HNSCC background does not adversely affect the clinical outcome of patients with superficial ESCC managed by ESD. OS and complication rates were similar between the two groups and consistent with findings from previous studies [9,17,18,[20][21][22][23][24][25][26][27][28][29][30][31].…”

“…Although ESD has been widely used in Japan for ESCC, in other countries, it is still considered a cumbersome and challenging procedure with a steep learning curve and high risk of complications. In our study, rates of overall curative resection, en bloc resection, R0 resection, and AEs were 71.9 %, 97.7 %, 92.1 % and 10.1 %, respectively, similar to other series of esophageal ESD [17][18][19]. Based on these results, esophageal ESD seems to be feasible in Western centers with a high success rate.…”

Outcomes of endoscopic submucosal dissection for early oesophageal squamous cell neoplasia at a Western centre

“…The efficacy and safety of ESD for ESCC has been demonstrated in many studies (more than 970 cases published) and a technical success rate of 99%. 3,8 The rate of local recurrence after ESD for ESCC ranges from 0-14%, 9,11,22,23,24,[25][26][27] with up to 11% metachronous recurrences. 29 We found a 7% (4/56) local recurrence rate, predictable from the 86% histologically complete resection rate, and a 14% metachronous recurrence rate, in keeping with larger monocentric studies.…”

Endoscopic diagnosis and treatment of early esophageal squamous neoplasia

“…All complications were successfully managed conservatively[ 48 ]. More recent studies show an en bloc resection rate between 83%-100%, R0 resection rate between 78%-100% and local recurrence rates of 0%-6%[ 49 - 57 ]. The experience of Western endoscopists with ESD in esophageal SCC was recently published.…”