Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

Abstract

Background Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan. Method We consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival. Results Total of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC. Conclusion ESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.

A Study on Risk Factors Associated with Reflux Esophagitis in Patients Undergoing Esophageal Cancer Surgery

“…Under normal conditions, the flake-like flapper effect of the lower esophageal sphincter and esophagogastric angle and the “spring clip” effect of the esophageal opening jointly form the antireflux mechanism. However, the esophageal cancer surgery negatively affects the antireflux mechanism because this treatment uses the stomach to replace the esophagus, completely destroying the integrity and anatomic structure of the esophagus [ 14 , 15 ]. This treatment places the stomach in the negative-pressure thoracic cavity, which increases the gastric tension and volume, and the breathing, cough with asthma, and abdominal pressure all affect the gastroesophageal pressure to varying degrees, allowing gastric contents to flow into the esophageal lumen.…”

Mechanisms of esophageal stricture after extensive endoscopic resection: a transcriptomic analysis

“…The expanding indications of esophageal ESD result in larger resection specimens and an increased frequency of post-endoscopic esophageal strictures [17,18]. There is no currently…”

“…The expanding indications of esophageal ESD result in larger resection specimens and an increased frequency of post-endoscopic esophageal strictures 17 18 . There is no currently recommended preventive treatment for these strictures, and their management relies on iterative endoscopic dilatation.…”

Biological and clinical significance of the YKL‐40/osteopontin–integrin β4–p70S6K axis induced by macrophages in early oesophageal squamous cell carcinoma

“…Oesophageal squamous cell carcinoma (ESCC) is highly prevalent in East Asia, southern and eastern Africa, and southern Europe [2]. Although the general outcome remains poor for 5‐year survival rates, ranging from 15% to 25% [3], the 10‐year disease‐related survival rate following endoscopic submucosal dissection (ESD) in early superficial ESCC is more than 90% [4]; thus, the detection and treatment of early ESCC are extremely important for improving survival.…”

“…metachronous ESCC) following ESD could occur in 0.9-9.1% of cases [3]. Lugol-voiding lesions (LVLs) on Lugol chromoendoscopy are known to be associated with high-risk metachronous ESCC [4,5]; however, molecular factors other than LVLs that predict metachronous ESCC have yet to be identified.…”