Evaluation of long-term survival in patients with severe comorbidities after endoscopic submucosal dissection for esophageal squamous cell carcinoma

Abstract

Background: Endoscopic submucosal dissection (ESD) is becoming widely popular as a less invasive treatment option for superficial esophageal squamous cell carcinoma.However, data on long-term survival after esophageal ESD in patients with severe comorbidities are limited. This study aimed to evaluate long-term survival after ESD in such patients.Methods: Altogether, 584 consecutive patients underwent esophageal ESD at our institution from May 2004 to September 2016. Based on the American Society of Anesthesiologists Physical Status (ASA-PS) classification system, patients were grouped according to severe (ASA-PS ≥3) or non-severe comorbidities (ASA-PS 1/2). The overall survival (OS), disease-specific survival (DSS), and risk factors for mortality were compared between the groups using a propensity score matching analysis.Results: In a matched cohort of 69 pairs, the 5-year OS rate was poorer in ASA-PS 3 patients than in ASA-PS 1/2 patients (63.9% vs. 92.5%, P < 0.01), while the 5-year DSS rate was similar between the groups (100% vs. 100%). The mortality rate was significantly higher in ASA-PS 3 patients than in ASA-PS 1/2 patients (hazard ratio, 3.47; 95% confidence interval 1.79-6.74; P < 0.01). Death due to exacerbation of comorbidities was significantly more frequent in ASA-PS 3 patients than in ASA-PS 1/2 patients (42.4% vs. 8.3%, P < 0.04).Conclusions: Because of the exacerbation of comorbidities, patients with severe comorbidities had poorer long-term outcomes after esophageal ESD than those with nonsevere comorbidities. Further studies will be necessary to evaluate esophageal ESD in patients with severe comorbidities.

Long‐term outcomes after endoscopic submucosal dissection for colorectal epithelial neoplasms in patients with severe comorbidities

“…Instead, the mortalities could be related to the exacerbation of comorbidities, such as pulmonary, cardiovascular, and cerebrovascular diseases, that existed before colorectal ESD. Similar results were demonstrated for the long‐term outcomes of gastric and esophageal ESD in patients with severe comorbidities categorized according to the ASA‐PS classification 26,27 …”

“…Similar results were demonstrated for the long-term outcomes of gastric and esophageal ESD in patients with severe comorbidities categorized according to the ASA-PS classification. 26,27 According to previous reports on the normal development of CRC, adenomas with an average size of 11.1 mm developed into advanced cancer in an average observation period of 64.5 months. 28 Considering this report, CEN measuring >20 mm, for which colorectal ESD is indicated, may develop into advanced cancers affecting the patient's prognosis in approximately 4-5 years.…”

“…Similar results were demonstrated for the long‐term outcomes of gastric and esophageal ESD in patients with severe comorbidities categorized according to the ASA‐PS classification. 26 , 27 …”

Management of Superficial Esophageal Squamous Cell Carcinoma and Early Gastric Cancer following Non-Curative Endoscopic Resection

“…Many patients with non-curative ER for SESCC die of non-ESCC-related causes [ 28 ]. Several retrospective studies have reported the prognostic factors in patients with ER for SESCC [ 49 , 50 , 51 , 52 , 53 , 54 ] ( Table 3 ), but the study populations and significant factors, except the Charlson comorbidity index (CCI), which is a 19-comorbidity tool with weighted points [ 55 ], differed across studies. Only one study evaluated the prognostic factors in patients with non-curative ER for SESCC [ 54 ].…”

Characteristics of esophageal squamous cell carcinomas resected by endoscopic submucosal dissection based on circumferential localization

“…In a Japanese report, the frequency of ESCC development was the highest in the middle thoracic esophagus (Mt), followed by the lower thoracic esophagus (Lt), and the upper thoracic esophagus (Ut) [5]. Although other studies have reported similar results in terms of the longitudinal location of ESCC lesions, there have been few reports on the frequency of ESCC lesions based on the circumferential location [5][6][7][8][9][10][11][12].…”