Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center
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Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophagealsquamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyzelong-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collecteddatabase. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria(M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%)had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It wasnot performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during amean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resectionwas 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overallsurvival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited andmainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophagealsquamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyzelong-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collecteddatabase. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria(M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%)had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It wasnot performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during amean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resectionwas 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overallsurvival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited andmainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.
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