Digestive Endoscopy
The five-year survival rate after endoscopic submucosal dissection for superficial esophageal squamous cell neoplasia

https://doi.org/10.1016/j.dld.2016.12.009Get rights and content

Abstract

Background

Endoscopic submucosal dissection (ESD) is a widely accepted procedure for superficial esophageal squamous cell neoplasia (ESCN) because of a high complete resection rate. However, there were a few reports about the long-term outcomes of these patients due to short follow-up periods.

Aims

We aimed to evaluate the 5-year survival after ESD for superficial ESCN.

Methods

This was a retrospective cohort study performed at a single institution. Between 2006 and 2009, 94 patients with superficial ESCN underwent ESD. Eighty-three patients (93.3%) who had completed an extended period of observation of at least 5 years were enrolled. The main outcomes were the 5-year survival rates. The secondary outcomes were the cumulative incidence rate of metachronous ESCN, and the clinical outcomes.

Results

The 5-year relative overall survival rate was 99.0%, whereas the cause specific survival rate was 100% during 72.9 months of median follow up period. Subgroup analysis showed that the 5 year survival of patients with EP/LPM and MM/SM1 (submucosal invasion ≤200 μm) were 100% and 89.0%, respectively. The cumulative incidence rate of metachronous ESCN at 5 years was 16.8%.

Conclusion

ESD for superficial ESCN is a curative treatment with a favorable 5-year survival rate.

Introduction

The prognosis of advanced-stage esophageal squamous cell carcinoma (ESCC) is poor even after surgical resection, chemotherapy, radiotherapy, or combination therapies [1], [2]. The long-term survival rates of ESCC have improved because of advances in detection at an earlier stage by using new optical imaging techniques, including narrow-band imaging (NBI) endoscopy and curative endoscopic resection [3], [4]. Endoscopic submucosal dissection (ESD) is widely accepted as a promising endoscopic treatment for superficial ESCC because of its higher en bloc and complete resection rates than those of conventional endoscopic mucosal resection (EMR) regardless of tumor size [5], [6]. However, the presence of residual esophageal mucosa after endoscopic resection is highly susceptible to the development of metachronous ESCC [7], [8].

Although favorable long-term outcomes of endoscopic resections have been reported [9], [10], [11], those studies have included heterogeneous groups of patients treated by ESD or conventional EMR so that they could not represent the true long-term outcomes and metachronous recurrence rate of patients treated by ESD for superficial ESCC [5], [12], [13], [14]. In conventional EMR, it is sometimes difficult to assess the margin, invasion depth, or lymphovascular involvement of cancer in piecemeal resection specimens, leading to higher residual and local recurrences [5]. Additional therapy could be administered to improve the long-term outcome and reduce metachronous recurrence rates. Furthermore, in previous reports, the follow-up of ESD for ESCC was too short to evaluate the long-term outcome and metachronous recurrence rate [5], [12], [13], [14].

Therefore, we conducted this study to analyze the 5-year survival and metachronous recurrence rates after ESD for superficial ESCC in patients who were followed for >5 years.

Section snippets

Patients

This was a retrospective cohort study performed at a single referral center. Between February 2006 and November 2009, 94 consecutive patients with superficial esophageal squamous cell neoplasia (ESCN) were enrolled and observed until November 2014 after undergoing ESD at our hospital. Absolute indications for ESD are determined by preoperative endoscopic evaluation and biopsy showing squamous cell esophageal carcinoma with clinical invasion depth limited to the lamina propria mucosae (LPM), or

Clinicopathological characteristics of patients

The flowchart of patient recruitment is shown in Fig. 1. Among the 94 patients with superficial ESCN who underwent ESD at our hospital, 4 with a history of radiotherapy or chemotherapy for ESCC and 1 with progressive hepatocellular carcinoma were excluded. Among the remaining 89 patients, 83 (93.3%) who had completed an extended period of follow-up of at least 5 years duration or had died after ESD were enrolled. Among the 83 patients, 60, 14, 5, and 4 cases were characterized by an invasion

Discussion

This study demonstrated that the 5-year observed overall survival rate of patients who had ESD for ESCN with an EP/LPM depth was favorable, and the 5-year cause-specific survival rate was excellent. However, the 5-year observed overall survival rates of patients with MM/SM1 and SM2 invasion depths were lower (84.2% and 75.0%) than those of patients with EP/LPM invasion, despite the absence of cause-specific mortality. Additionally, the 5-year relative survival rates of patients with EP/LPM and

Conflict of interest

Dr. Tetsuo Arakawa had advisory committee memberships at Otsuka Pharmaceutical Co., Ltd. and Eisai Co., Ltd. Dr. Toshio Watanabe had advisory committee memberships at Eisai Co., Ltd. Drs. Nagami, Ominami, Shiba, Minamino, Fukunaga, Kameda, Sugimori, Machida, Tanigawa, Yamagami, Tominaga, and Fujiwara declare that they have no conflicts of interest or financial ties to disclose.

Funding

None.

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