Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center

  • Andreas Probst (Department of Gastroenterology, University Hospital Augsburg) ;
  • Alanna Ebigbo (Department of Gastroenterology, University Hospital Augsburg) ;
  • Stefan Eser (Department of Gastroenterology, University Hospital Augsburg) ;
  • Carola Fleischmann (Department of Gastroenterology, University Hospital Augsburg) ;
  • Tina Schaller (Institute of Pathology and Molecular Diagnostics, University Hospital Augsburg) ;
  • Bruno Markl (Institute of Pathology and Molecular Diagnostics, University Hospital Augsburg) ;
  • Stefan Schiele (Institute of Mathematics and Computational Statistics, University of Augsburg) ;
  • Bernd Geissler (Department of General, Visceral and Transplant Surgery, University Hospital Augsburg) ;
  • Gernot Muller (Institute of Mathematics and Computational Statistics, University of Augsburg) ;
  • Helmut Messmann (Department of Gastroenterology, University Hospital Augsburg)
  • Received : 2022.03.05
  • Accepted : 2022.04.29
  • Published : 2023.01.30
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Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. 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 was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean 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 resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival 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 and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

Keywords

References

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