cT1N0M0 Esophageal Squamous Cell Carcinoma Invades the Muscularis Mucosa or Submucosa: Comparison of the Results of Endoscopic Submucosal Dissection and Esophagectomy

Abstract

Background: Endoscopic submucosal dissection (ESD) combined with selective adjuvant chemoradiotherapy may be a new treatment option for cT1N0M0 esophageal squamous cell carcinoma (ESCC) invading muscularis mucosa or submucosa (pT1a-M3/pT1b). We aim to report the effectiveness of this treatment by comparing the results of esophagectomy. Methods: This retrospective single-center study included 72 patients with pT1a-M3/pT1b ESCC who received ESD combined with selective adjuvant chemoradiotherapy (n = 40) and esophagectomy (n = 32). The main outcome comparison was overall survival (OS). The secondary outcomes were treatment-related events, including operation time, complication rate, and length of hospital stay. Disease-specific survival (DSS) and progression-free survival (PFS) were also evaluated. Results: There were no significant differences in the rates of OS, DSS, and PFS between the two groups (median follow-up time: 49.2 months vs. 50.9 months); these were also the same in the subgroup analysis of pT1b ESCC patients. In the ESD group, the procedure time, overall complication rates, and length of hospital stay were significantly reduced. However, the metachronous recurrence rate was significantly higher. In a multivariate analysis, tumor depth and R0 resection were the independent factors associated with OS. Conclusions: ESD combined with selective adjuvant chemoradiotherapy can be an alternative treatment to esophagectomy for cT1N0M0 ESCC invading muscularis mucosa or submucosa.

Comparison of Long-Term Survival Between cT1N0 Stage Esophageal Cancer Patients Receiving Endoscopic Dissection and Esophagectomy: A Meta-Analysis

“…Actually, we deem that there are still some valuable fields worthy of more depth investigations about the ED for early stage esophageal cancer. For example, some scholars indicated that T1b stage patients who undergoing ESD should receive adjuvant therapies like the chemotherapy, but others had different opinions ( 40 ). Furthermore, it is also necessary to compare the therapeutic effects of ED combined chemotherapy and esophagectomy for cT1N0 stage esophageal cancer patients.…”

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

“… 5 In pT1a-M3/pT1b SESCC, patients who were treated with ESD had comparable OS ( p = 0.419), DSS ( p = 0.436), and PFS ( p = 0.176) to those treated with esophagectomy. 29 An et al. 11 conducted a study to compare ESD with esophagectomy under different depth of tumor invasion, and found that there were no significant differences in OS ( p = 0.417), DSS ( p = 0.423), and RFS ( p = 0.726) between the two groups.…”

“… 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. In the pT1a-M1/M2 and pT1a-MM/pT1b subgroups, there were no significant differences between the ESD and esophagectomy groups in terms of all-cause mortality, recurrence rate, and disease-specific mortality.…”

“…Therefore, we compared the Previous studies have compared the outcomes of endoscopic treatment and surgical resection for the SESCC, and showed no difference in survival or risk of cancer recurrence or metastasis in treated with esophagectomy. 29 30,31 We recommend additional treatment for patients who underwent ESD in our study with positive margins, but the final decision was based on the patient's physical condition and preference. 32 Concerning survival outcomes, we found that the ESD group had better OS (p = 0.014) and DSS (p = 0.012), while RFS (p = 0.051) was comparable between the two groups.…”

Analysis of lymph node metastasis and prognostic risk factors in superficial esophageal squamous cell carcinoma

“…Although surgical techniques and facilities have improved, there is still a substantial rate of morbidity associated with surgery 6 . Endoscopic submucosal dissection (ESD) represents a safe and effective alternative therapy in the case of SESCC invading the epithelium (M1) or the lamina propria (M2) 7 . Nevertheless, metastatic lymph nodes cannot be removed with ESD, only the primary tumor.…”