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

Abstract

Background and aims Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma. However, data from Western centres are scarce. Methods We conducted a retrospective study from a prospectively collected database at a tertiary care centre in France. All consecutive patients undergoing endoscopic submucosal dissection for oesophageal squamous cell carcinoma were included. The main outcome was the curative resection rate. Secondary outcomes were en-bloc resection rates, histologically complete resection rates, morbidity, recurrence-free and overall survival. Results Fifty-six cases of oesophageal squamous cell carcinoma (49 patients; mean age 61.5 ± 10 years; 36 men) were included. En-bloc, histologically complete and curative resection rates were 98%, 86% and 71%, respectively. Fifteen (30%) patients received an additional treatment after endoscopic submucosal dissection, nine treated by chemoradiotherapy, four by surgery and two by further endoscopic submucosal dissection. Within a mean follow-up of 21 ± 15 months, recurrences occurred in 14 (29%) patients (four local, eight metachronous and three distant recurrences). Eight patients died during follow-up, of which two (4%) patients died from oesophageal squamous cell carcinoma. Factors significantly associated with mortality in this series were: moderate or poor differentiation of oesophageal squamous cell carcinoma ( p = 0.02) and recurrence of oesophageal squamous cell carcinoma ( p = 0.028). Conclusion Moderately or poorly differentiated cancer is a major prognostic factor and should probably be taken into account when indicating an additional treatment after endoscopic submucosal dissection. Close endoscopic follow-up is essential considering the high recurrence rate.

Long-term outcome of endoscopic resection for intramucosal esophageal squamous cell cancer: a secondary analysis of the Japan Esophageal Cohort study

“…Occasionally, geographic variations in diseases and medical situations are observed. However, similar studies have recently been reported from the West based on retrospective analyses [28,29]. We believe our study results can be adapted to the West.…”

Is Lugol necessary for endoscopic resection of esophageal squamous cell neoplasia?

“…In the current study, the complete lateral resection rate was 66 % for dysplasia and 92 % for invasive carcinoma, comparable to that described in two single-center and one multicenter study on endoscopic resection of early esophageal SCC (lateral margins positive for carcinoma in 8.3 % to 9.5 % of lesions) [21][22][23]. It is interesting to note that local recurrence rate was inferior to complete lateral resection rate for dysplasia which may be due to pathological examination limitations due to cautery artifacts or due to cautery effect on non-resected adjacent mucosa.…”

Long-Term Survival in Endoscopic Resection Followed By Additional Chemoradiotherapy For Early-Stage Esophageal Cancer Compared to Esophagectomy: A Systematic Review and Meta-Analysis

“…Analysis included a total of 369 patients from eight studies [16,17,[19][20][21][22][23][24]. A statistically signi cant improvement in recurrence and metastasis rate was observed for esophagectomy when compared to the CRT (OR = 5.25, 95% CI 2.33-11.80, P <0.001).…”

“…Seven studies represented a total of 828 patients, with 653 esophagectomy and 175 controls [16,17,20,[22][23][24][25]. No statistically signi cant OS difference could be established between the both sides (HR=1.26, 95% CI: 0.75-2.11, P = 0.38), with a low between-study heterogeneity (I 2 = 16%, P = 0.31) (Fig.…”