Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are promising therapeutic options for early esophageal cancer (EC). The factors that can affect mid- and long-term survival in patients with submucosal EC (SM1 and SM2) have not been described in the literature. We aim to describe clinicopathological outcomes and factors that can affect the mid- and long-term survival in patients with resected submucosal tumors. Patients and methods We performed a retrospective analysis of patients who underwent endoscopic resection (ER) for submucosal tumors over a 20-year period. The final study population included 119 cases with 137 lesions. Information was collected according to the Japanese Classification of Esophageal Cancer 11-edition and factors affecting survival for 2 and 5 years after ER were analyzed. Results EMR was performed in 99 cases (72.3 %), ESD in 38 cases (27.7 %). There were no significant complications. Two- and 5-year survival rates were 91 % and 82 %, respectively. Mean age was 67.22 years (± 9.49 years), mortality caused by EC occurred in 13 cases (11 %). Factors that had a significant impact on long-term survival were age > 65 years (P = 0.0026), number of resected specimens (P = 0.0031), presence of another progressive disease (not EC) (P ≤ 0.001), recurrence (P = 0.0002), and relation between histopathological positive vertical margin and recurrence (P = 0.0112). Conclusions ER is viable treatment for esophageal submucosal cancer, selection between ESD/EMR can depend on tumor size and patient condition, and en bloc ER is the recommended technique for submucosal tumors. Long-term survival factors were identified.

Downregulated lncRNA UCA1 acts as ceRNA to adsorb microRNA-498 to repress proliferation, invasion and epithelial mesenchymal transition of esophageal cancer cells by decreasing ZEB2 expression

“…Esophageal cancer (EC) is one of the 10 most widespread newly diagnosed cancers in the world and the sixth most general reasons of death from cancer [1]. EC usually happens as either squamous cell carcinoma in the middle or upper one-third of the esophagus, or as adenocarcinoma in the lower one-third or junction of the esophagus and stomach [2].…”

Effect of endoscopic mucosal resection and endoscopic submucosal dissection on postoperative wound bleeding‐related complications in patients with superficial esophageal cancer: A meta‐analysis

“…EMR is highly effective for small gastrointestinal tumors. 3 EMR, however, offers only a partial excision in many instances, which restricts the location of the boundary of the lesion and therefore raises the risk of local recurrence after surgery. 4 ESD is one of the most commonly used methods to treat digestive system tumors, including esophageal and stomach diseases.…”

“…EMR and ESD are widely used. EMR is highly effective for small gastrointestinal tumors 3 . EMR, however, offers only a partial excision in many instances, which restricts the location of the boundary of the lesion and therefore raises the risk of local recurrence after surgery 4 …”

Endoscopic therapy versus esophagectomy for T1bN0M0 esophageal cancer: A population-based study using propensity score matching

“…SM1 lesions are confined to the superficial submucosa, with a restricted depth of 200 mm for esophageal squamous cell carcinoma (ESCC) and 500 mm for esophageal adenocarcinoma (EAC). In contrast, SM2 and SM3 tumors extend into the submucosa, with depths exceeding 200 mm for ESCC or surpassing 500 mm for EAC [ 7 ].…”