Risk of metastatic recurrence after endoscopic resection for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa: a multicenter retrospective study

Hatta, Waku; Koike, Tomoyuki; Takahashi, So; Shimada, Tomohiro; Hikichi, Takuto; Toya, Yosuke; Tanaka, Ippei; Onozato, Yusuke; Hamada, Koichi; Fukushi, Daisuke; Watanabe, Ko; Kayaba, Shoichi; Ito, Hirotaka; Mikami, Taisei; Oikawa, Takuya; Kondo, Yutaka; Yoshimura, Teizo; Shiroki, Takeharu; Nagino, Ko; Hanabata, Norihiro; Funakubo, Akira; Hirasawa, Dai; Ohira, Tetsuya; Nakamura, Jun; Matsumoto, Takayuki; Nakamura, Tomohiro; Nakaya, Naoki; Iijima, Katsunori; Fukuda, Shinsaku; Masamune, Atsushi

doi:10.1007/s00535-021-01787-y

Cited by 29 publications

(44 citation statements)

References 26 publications

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“…In addition, RFS was significantly worse in the pT1b‐SM1 and pT1b‐SM2 group than in the pT1a‐MM group, but those in the pT1b‐SM1 and pT1b‐SM2 groups were similar (Figs 2b, S1b). In contrast, a recent retrospective study claimed that the metastatic risk of pT1b‐SM1 was similar to that of pT1a‐MM, rather than pT1b‐SM2 16 . The differences of one or two cases of metastasis in both studies influenced this interpretation because of the limited number of pT1b‐SM1 cases without LVI.…”

Section: Discussionmentioning

confidence: 88%

“…The favorable result of our cohort is attributed to the fact that 62.5% (5/8) of the metastatic recurrent cases were detected as the regional LNs, which is related to a favorable outcome; 19 at a median follow‐up of 50 months after the recurrence, none of the patients died due to ESCC. Similarly, out of 23 patients in a retrospective study, six with metastatic recurrence died of ESCC, whereas 10 out of 15 patients with locoregional metastasis were treated with no recurrence 16 . Surveillance is important for patients with a high risk of metastasis, because earlier detection is valuable.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of esophageal squamous cell carcinoma with invasion depth of pathological T1a‐muscularis mucosae and T1b‐submucosa by endoscopic resection followed by appropriate additional treatment

Naito

Yoshio

Ishiyama

et al. 2021

Digestive Endoscopy

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Objectives Endoscopic resection (ER) is indicated for a wide range of superficial esophageal squamous cell carcinomas (ESCCs). We examined the long‐term outcomes in patients with pathological (p) invasion of ESCC into the T1a‐muscularis mucosae (MM) and T1b‐submucosa (SM) after ER, for which data on prognosis are limited. Methods Of the 1217 patients with superficial ESCC who underwent ER, 225 patients with a pathological diagnosis of ESCC invasion into the MM, minute submucosal invasion ≤200 µm (SM1), or massive submucosal invasion (SM2) were included. In patients with lymphovascular invasion, droplet infiltration, or SM2 invasion, additional treatments, including chemoradiation (CRT) or esophagectomy with two‐ to three‐field lymph node dissection, were recommended. The median observation period was 66 months (interquartile range 48–91 months). Results In total, there were 151, 28, and 46 pT1a‐MM, pT1b‐SM1, and pT1b‐SM2 cases, respectively. Metastatic recurrence was observed in 1.3%, 10.7%, and 6.5% patients with pT1a‐MM, pT1b‐SM1, and pT1b‐SM2 ESCCs, respectively. Of the eight patients with metastatic recurrence, six were successfully treated, and two died of ESCC. The 5‐year overall survival rates were 84.1%, 71.4%, and 67.4%, the 5‐year relapse‐free survival rates were 82.8%, 64.3%, and 65.2%, and the 5‐year disease‐specific survival rates were 100%, 96.4%, and 99.1% in patients with pT1a‐MM, pT1b‐SM1, and pT1b‐SM2 ESCCs, respectively. Multivariate analysis showed that additional CRT and esophagectomy, and T1b‐SM2 were positively and negatively associated with overall survival, respectively. Conclusions Endoscopic resection preceding appropriate additional treatments resulted in favorable outcomes. Many cases of metastatic recurrence in this cohort could be successfully treated.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of esophageal squamous cell carcinoma with invasion depth of pathological T1a‐muscularis mucosae and T1b‐submucosa by endoscopic resection followed by appropriate additional treatment

Naito

Yoshio

Ishiyama

et al. 2021

Digestive Endoscopy

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“…Such patients may have a risk of delay in receiving definitive treatment, such as esophagectomy or chemoradiotherapy (CRT). Although SESCCs with pT1b-SM2 have a risk of metastatic recurrence (23.6% in five years) when additional treatment is not received [6], a recent multicenter prospective study revealed the efficacy of the combination of ER and selective CRT, which is comparable to the efficacy of esophagectomy [24]. Considering that ER is a minimally invasive treatment method and the selection of esophagectomy or CRT by overdiagnosis of the invasion depth may be a disadvantage, the selection of ER based on B2 vessels might be acceptable.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal cancer is the seventh leading cause of the cancer incidence and the sixth leading cause of cancer death [1], and esophageal squamous cell carcinoma accounts for 84% of cases with esophageal cancers [2,3]. Endoscopic resection (ER) is a minimally invasive treatment method for superficial esophageal squamous cell carcinoma (SESCC) without lymph node metastasis [4], and favorable long-term outcomes have been reported [5][6][7]. According to the latest Japanese guidelines [8], ER is recommended for tumors confined to the epithelium or lamina propria mucosa (cT1a-EP/LPM) or those invading into the muscularis mucosa or submucosa ≤200 µm (cT1a-MM/T1b-SM1) when the tumors are not circumferential.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification

et al. 2021

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Blue light imaging (BLI) and narrow-band imaging (NBI) are two modalities that enable narrow-band light observation. We aimed to compare the diagnostic ability of magnifying endoscopy with BLI (ME-BLI) and NBI (ME-NBI) for determining the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by the Japanese Esophageal Society’s intrapapillary capillary loop (IPCL) classification. We enrolled 81 patients between 2014 and 2018, and the still endoscopic images for diagnosing the invasion depth at the same part in ME-BLI and ME-NBI were registered. Two blinded investigators reviewed them and diagnosed the invasion depth by the IPCL classification. Subsequently, the diagnostic yields in two modalities were compared. The overall accuracies for the invasion depth by the IPCL classification in ME-BLI and ME-NBI did not differ significantly (67.9–71.6% vs. 72.8–74.1%). In the analysis based on the invasion depth, the sensitivities and positive predictive values in tumors invading the muscularis mucosa or submucosa ≤200 µm were low (23.1–30.8% and 16.7–25.0%, respectively) in both modalities. In conclusion, the diagnostic ability for determining the invasion depth of SESCC by the IPCL classification was relatively similar in ME-BLI and ME-NBI, but diagnosis by magnifying endoscopy alone might not be satisfactory.

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“…Endoscopic submucosal dissection (ESD) is now widely accepted as a minimally invasive treatment method for early‐stage esophageal and gastric cancers, particularly in Eastern Asian countries. 1 , 2 , 3 , 4 , 5 , 6 In addition, many reports have shown favorable long‐term outcomes after ESD for such tumors, irrespective of the curative status, 6 , 7 , 8 , 9 , 10 , 11 and risk of lymph node metastasis or recurrence in noncurative resection. 12 , 13 , 14 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

et al. 2021

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Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

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Risk of metastatic recurrence after endoscopic resection for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa: a multicenter retrospective study

Cited by 29 publications

References 26 publications

Long‐term outcomes of esophageal squamous cell carcinoma with invasion depth of pathological T1a‐muscularis mucosae and T1b‐submucosa by endoscopic resection followed by appropriate additional treatment

Long‐term outcomes of esophageal squamous cell carcinoma with invasion depth of pathological T1a‐muscularis mucosae and T1b‐submucosa by endoscopic resection followed by appropriate additional treatment

Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

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