Close Observation versus Additional Surgery after Noncurative Endoscopic Resection of Esophageal Squamous Cell Carcinoma

Abstract

<b><i>Introduction:</i></b> After noncurative endoscopic submucosal dissection (ESD) of superficial esophageal squamous cell carcinoma (SESCC), additional esophagectomy is generally recommended. However, considering its high mortality and morbidity, it is uncertain if additional surgery improves the clinical outcomes. This study aimed to compare the clinical outcomes between patients who were observed without additional treatment and those who underwent radical esophagectomy. <b><i>Methods:</i></b> A total of 52 patients with SESCC who underwent complete but noncurative ESD from January 2008 to December 2016 at the Samsung Medical Center and Asan Medical Center in Korea were retrospectively analyzed. Clinicopathologic characteristics and oncologic outcomes were compared between the observation group (<i>n</i> = 23) and the additional surgery group (<i>n</i> = 29). <b><i>Results:</i></b> During a mean follow-up of 34.4 and 41.7 months, respectively, the rates of death (observation vs. surgery, 17.4 vs. 10.3%; <i>p</i> = 0.686), recurrence (observation vs. surgery, 13 vs. 17.2%; <i>p</i> = 1.000), and disease-specific death (observation vs. surgery, 4.3 vs. 6.9%; <i>p</i> = 1.000) did not significantly differ between the 2 groups. The 3-year overall survival was 86.3 and 96.4%, respectively (<i>p</i> = 0.776). The 3-year recurrence-free survival (observation vs. surgery, 85.0 vs. 88.7%; <i>p</i> = 0.960) and disease-specific survival (observation vs. surgery, 95.2 vs. 96.4%; <i>p</i> = 0.564) also did not significantly differ. <b><i>Conclusions:</i></b> The clinical outcomes of close observation of noncuratively resected SESCC are comparable to those of additional surgery, at least in the midterm. The wait-and-see strategy could be a feasible management option after noncurative ESD of SESCC in selected patients.

Endoscopic submucosal dissection versus esophagectomy for t1 esophageal squamous cell carcinoma: a propensity score-matched analysis

“…Our results are similar to those reported previously. 4,19,33 In the matched cohorts, there was no significant difference in OS (p = 0.566), RFS (p = 0.586), and DSS (p = 0.912) between the two groups. 9,29 Subgroup analysis based on the depth of invasion was used to compare survival outcomes.…”

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

“…6 However, the incidence of postoperative complications after MIE can be high due to the anatomical characteristics of the esophagus. 5 , 6 Among them, anastomotic leakage is the most common complication after MIE and is associated with prolonged hospital stay and increased risk of mortality. 7 The treatment of anastomotic leakage is difficult, costly, is associated with prolonged hospitalization and may affect the long-term prognosis.…”

“…[1][2][3] Surgery is considered a primary treatment for EC. Minimally invasive esophagectomy (MIE) is currently a procedure of choice in clinical practice, 4,5 as it is generally safe and results in a radical resection. 6 However, the incidence of postoperative complications after MIE can be high due to the anatomical characteristics of the esophagus.…”