Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis

Yeh, Jen‐Hao; Huang, Ruyi; Lee, Ching‐Tai; Lin, Chun-Cheng; Hsu, Meng‐Hsiang; Wu, Tsung‐Chin; Hsiao, Po‐Jen; Wang, Wen‐Lun

doi:10.1177/1756284820964316

Cited by 24 publications

(23 citation statements)

References 51 publications

(265 reference statements)

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“…Therefore, we identified the short- and long-term outcomes and prognostic factors of patients aged ≥ 65 years who underwent ESD or surgical resection for SEC. The short-term outcomes of en bloc resection (94.5 vs. 97.1%), R0 resection (90.0 vs. 92.0%), curative resection (71.0 vs. 73.0–90.5%), perforation (3.8 vs. 0.0–12.1%), bleeding (1.0 vs. 2.0%), and stricture (18.6 vs. 5.1–25.9%) were similar to those reported in a previous meta-analysis study ( 31 ). The five-year OS (73.1 vs. 87.3%) and disease-specific survival (89.8 vs. 97.7%) rates were lower than those reported in the previous meta-analysis study (mean age: 70.9 vs. 64–71 years) ( 31 ).…”

Section: Discussionsupporting

confidence: 88%

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Long-Term Outcomes and Prognostic Factors of Superficial Esophageal Cancer in Patients Aged ≥ 65 Years

et al. 2022

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BackgroundThe number of elderly patients with superficial esophageal cancer (SEC) is increasing. We aimed to evaluate the clinical outcomes and prognostic factors of overall survival (OS) in elderly patients undergoing endoscopic submucosal dissection (ESD) or surgical resection for SEC.MethodsBetween January 2001 and May 2020, 290 patients aged ≥65 years who underwent ESD or surgical resection for SEC were evaluated. Their clinical outcomes and prognosis were assessed, and independent risk factors for OS were identified.ResultsThe mean patient age (269 men and 21 women) was 70.9 years (range 65–90 years). En bloc, R0, and curative resections were achieved in 94.5%, 90.0%, and 73.4% of the patients, respectively. During the follow-up [mean: 54.6 months (range: 1–210 months)], 79 patients died. The 3-, 5-, and 10-year OS rates were 82.5, 73.1, and 59.7%, respectively. In multivariate analysis, cancer history of the other organs, American Society of Anesthesiologists performance status, and presence of lymphovascular involvement (hazard ratio = 1.852, 1.656, and 1.943, respectively; all P < 0.05) were independent risk factors for poor OS. The high-risk group (≥2 risk factors) showed a significantly lower OS than the low-risk group (≤ 1 risk factor) (P < 0.001).ConclusionsThe three risk factors could be useful in predicting the long-term prognosis of elderly patients with SEC.

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Section: Discussionsupporting

confidence: 88%

“…In a meta-analysis ( 31 ), the 5-year OS (86.4 vs. 81.8%) and disease-specific survival (97.5 vs. 94.1%) rates of ESD and surgical resection were similar. It is unclear whether ESD or surgical resection is appropriate for elderly SEC patients.…”

Section: Discussionmentioning

confidence: 94%

Long-Term Outcomes and Prognostic Factors of Superficial Esophageal Cancer in Patients Aged ≥ 65 Years

et al. 2022

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“…Long-term outcomes were recently analyzed in a systematic review and meta-analysis that included 3796 patients and 5 comparative studies [77]. In terms of the comparison between ESD and esophagectomy, there was no difference in the OS (86.4 % vs. 81.8 %; hazard ratio 0.66, 95 %CI 0.39-1.11) as well as in DSS and recurrence-free survival.…”

Section: Comparison With Surgerymentioning

confidence: 99%

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Pimentel‐Nunes

Libânio

Bastiaansen³

et al. 2022

Endoscopy

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Main recommendationsESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett’s esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.

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“…We recently reported a meta-analysis to evaluate the efficacy and safety of ESD for SECC, in which the mean en bloc and R0 resection rates for ESD were 97.1% and 92.0%, respectively. The most commonly reported adverse events after ESD were perforation/mediastinal emphysema (3.4%), bleeding (2.0%), and stricture formation (9.4%) [ 14 ]. In the present study, the complete resection rate was more than 85% and the complication rate was less than 5%, indicating the efficacy and safety of the ESD technique at our high-volume referral center.…”

Section: Discussionmentioning

confidence: 99%

“…We recently reported a meta-analysis comparing the long-term outcomes of ESD and esophagectomy in treating SESCC, and found that ESD had similar efficacy to esophagectomy with far fewer lower perioperative adverse events. The 5-year overall, disease-specific and recurrence-free survival rates of ESD were 87.3%, 97.7% and 85.1%, respectively [ 14 ]. However, few studies except for Japan have reported the long-term outcomes of SESCC after ESD.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

et al. 2021

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Background Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan. Method We consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival. Results Total of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC. Conclusion ESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.

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Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis

Cited by 24 publications

References 51 publications

Long-Term Outcomes and Prognostic Factors of Superficial Esophageal Cancer in Patients Aged ≥ 65 Years

Long-Term Outcomes and Prognostic Factors of Superficial Esophageal Cancer in Patients Aged ≥ 65 Years

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

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