Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper

Shimizu, Yuichi; Tsukagoshi, Hiroyuki; Fujita, Masahiro; Hosokawa, Masao; Kato, Mototsugu; Asaka, Masahiro

doi:10.1067/mge.2002.127100

Cited by 57 publications

(75 citation statements)

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“…In cases showing tumor invasion to the muscularis mucosa (m3) or the submucosa < 200 μm from the muscularis mucosa (sm1), ER should be decided based on the risk of lymph node metastasis because the incidence of lymph node metastasis is known to be associated with the depth of invasion [23,31]. There have been efforts to expand the indications for ESD, based on reported favorable outcomes of ER for m3 or sm1 tumors [11,32,33]. One study recommended ER when the SEN had a size less than 25 mm, a lamina propria invasion width of less than 2,500 μm, and no evidence of lymphatic invasion [33].…”

Section: Discussionmentioning

confidence: 99%

“…There have been efforts to expand the indications for ESD, based on reported favorable outcomes of ER for m3 or sm1 tumors [11,32,33]. One study recommended ER when the SEN had a size less than 25 mm, a lamina propria invasion width of less than 2,500 μm, and no evidence of lymphatic invasion [33]. The other study suggested that patients with m3 tumors should be carefully observed without additional treatment after ER, especially when the invasion width of the lower muscularis mucosa was less than 3,000 μm [26].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, stricture was detected in 17 cases (6.5%) and the risk of stricture was higher in patients with lesions involving more than 3/4 of the luminal circumference. Post-ESD stricture can be successfully managed with EBD [33]. Local injection or oral administration of steroids was recently reported as an effective strategy for preventing post-ESD stricture [38][39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

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Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Park

Kim

Gong

et al. 2016

JCO

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(range, 44 to 86), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range, 5 to 85) and median procedure time was 45 minutes (range, 9 to 160). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range, 18 to 62), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Park

Kim

Gong

et al. 2016

JCO

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“…On the other hand, SM2-grade cancer (that invading the submucosa more than 200 µm below the muscularis mucosae) has a high frequency of lymph node metastasis (around 40%) and therefore ER is not recommended [1,9] . Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy [10][11][12][13][14][15][16] . However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence [17] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Honda

Akiho

2012

WJGP

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Endoscopic resection is an effective treatment for noninvasive esophageal squamous cell neoplasms (ESCNs). Endoscopic mucosal resection (EMR) has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy. However, EMR is limited in resection size and therefore piecemeal resection is performed for large lesions, resulting in an imprecise histological evaluation and a high frequency of local recurrence. Endoscopic submucosal dissection (ESD) has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs. ESD enables esophageal lesions, regardless of their size, to be removed en bloc and thus has a lower local recurrence rate than EMR. The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected. However, esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference; such a stricture requires multiple sessions of endoscopic balloon dilatation.Recently, oral prednisolone has been reported to be useful in preventing post-ESD stricture. In addition, a combination of chemoradiotherapy (CRT) and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive; CRT has a higher local recurrence rate than esophagectomy but is less invasive. ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

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“…Treatment selection for m3 or sm1 esophageal cancer include EMR/ESD, surgery and chemoradiotherapy. a search was conducted on PubMed for treatments using the keywords: superficial (or early) esophageal cancer, EMR, surgery and radiation for the period 1998-2008, and the results are shown in Table V ( [20][21][22]. No report discussed the long-term outcome of chemoradiation; thus Table V includes findings on only radiation.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

Ozawa¹,

Saikawa²,

Kitagawa³

2010

Oncology Letters

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Abstract.We studied the surgical treatments of patients with either esophageal cancer reaching to the muscularis mucosae (m3) or with a slight invasion of the submucosa (sm1). We reviewed the records and examined the clinicopathological features of 29 patients with m3 or sm1 esophageal squamous cell carcinoma who had undergone surgery. Lymph node metastasis was noted in 6.3% (1 patient) of patients with m3 cancers and in 38.5% (5 patients) of those with sm1 cancers. The incidence of lymph node metastasis was higher in the sm1 than in the m3 group, but the difference was not significant. Lymphatic invasion (ly) was noted in 12.3% (2 patients) of patients with m3 cancers and in 53.8% (7 patients) of those with sm1 cancers. The incidence of ly was significantly higher in the sm1 group than in the m3 group (P<0.05). In a multivariate analysis of factors for predicting lymph node metastasis, the presence of ly was the only significant predictor (P<0.05). The preoperative diagnostic accuracies of endoscopic ultrasonography (EUS), esophagogastroduodenoscopy (EGD) and an upper gastrointestinal series (UGS) for predicting depth of invasion were 27.8, 31.0 and 41.4%, respectively, with the majority of the misdiagnoses being overestimations. In conclusion, we suggested that ly is associated with lymph node metastasis in m3 or sm1 esophageal cancer. This association is significant for treatment-related decision making. IntroductionRecent diagnostic developments have led to the detection of superficial esophageal cancer. Consequently, an increase in the number of candidates for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been noted. Esophageal cancers extending to the intraepithelium (m1) or lamina propria (m2), in particular, rarely have lymph node metastasis or lymphatic invasion (ly) and are thus curative by local treatment and suitable for treatment with EMR/ ESD (1,2). On the other hand, the frequency of lymph node metastasis from cancer of the muscularis mucosa (m3) or the upper third of the submucosal layer (sm1) is 18.0 and 53.1%, respectively (3). In certain cases local treatment alone would be adequate; however, in other cases treatment for lymph node metastasis would need to be considered. Treatment strategies for m3 and sm1 cancers remain controversial. To provide appropriate treatment for these types of cancer, it would be useful to be able to identify patients that need treatment for lymph node metastasis. Diagnosis of lymph node metastasis from esophageal cancer by computed tomography (CT), ultrasonography and FDG-PET currently lacks accuracy. Subsequently, the accurate diagnosis of esophageal cancer prior to treatment presents a challenge. Depth of superficial esophageal cancer is normally diagnosed using endoscopy, endoscopic ultrasonography and a gastrointestinal series. However, despite the availability of these current modalities, accurate diagnosis of tumor depth remains difficult. If a clear diagnosis prior to treatment for m3 and sm1 esophageal cancer and accurate ...

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Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper

Cited by 57 publications

References 0 publications

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Surgical treatments for squamous cell carcinoma of the esophagus reaching to the muscularis mucosa or the upper third of the submucosal layer

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