Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study

Joseph, Abel; Draganov, Peter V.; Maluf‐Filho, Fauze; Aihara, Hiroyuki; Fukami, Norio; Sharma, Neil; Chak, Amitabh; Yang, Dennis; Jawaid, Salman; Dumot, John A.; Alaber, Omar A.; Chua, Tiffany; Singh, Ritu; Mejia-Perez, Lady Katherine; Lyu, Ruishen; Zhang, Xuefeng; Kamath, Suneel D.; Jang, Sunguk; Murthy, Sudish C.; Vargo, John J.; Bhatt, Amit

doi:10.1016/j.gie.2022.02.018

Cited by 22 publications

(11 citation statements)

References 36 publications

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“…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.…”

Section: Discussionmentioning

confidence: 90%

“…Recent evidence showed similar long-term outcomes between patients receiving ESD versus surgery. 10 , 18 , 19 However, there are still limited studies that compare ESD and esophagectomy in pT1a-MM/pT1b tumors, which were considered as the relative indications for ESD. Thus, this study aimed to evaluate the clinical outcomes of ESD and esophagectomy in patients with T1 ESCC.…”

Section: Introductionmentioning

confidence: 99%

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

Qian

Feng

Zhou

et al. 2022

Therap Adv Gastroenterol

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Background: Endoscopic submucosal dissection (ESD) has been a preferred treatment option for superficial esophageal squamous cell carcinoma (SESCC). Objectives: To compare the outcomes of ESD and esophagectomy in the treatment of SESCC, especially for lesions invading muscularis mucosa or submucosa (pT1a-MM/T1b). Design: We retrospectively analyzed data from patients with SESCC who underwent ESD or esophagectomy between 2015 and 2021. Methods: After propensity score matching, overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related events were compared between the ESD and esophagectomy groups. Furthermore, we performed a Cox regression analysis to identify factors associated with survival. Results: OS and DSS were significantly higher in the ESD group ( n = 508) than that in the esophagectomy group ( n = 466). After matching, 404 patients (202 per group) were included in the study. No significant differences were found between the ESD and esophagectomy groups in OS ( p = 0.566), RFS ( p = 0.586), and DSS ( p = 0.912). The ESD group showed less blood loss, shorter procedure duration and hospital stay, lower hospital cost, and fewer adverse events. However, a lower R0 resection rate was observed in the ESD group compared to the esophagectomy group. Subgroup analysis showed comparable survival outcomes between the two groups. In Cox regression analysis, age was the independent factor associated with OS. Conclusion: In the treatment of SESCC, ESD showed sufficient safety and advantages. Even for pT1a-MM/pT1b SESCC, ESD may be an alternative treatment to esophagectomy.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Qian

Feng

Zhou

et al. 2022

Therap Adv Gastroenterol

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“…The values of the relative risk pair odds ratio of unmeasured confounding affecting adjuvant radiotherapy choice (OR RT-U ) and hazard ratio (HR) of unmeasured confounding affecting OS (HR OS-U ) were set from 1.0 to 5.0 and 0.2, respectively. Based on the HR value of RT vs non-RT in the LVI+ group after PSM, the adjusted HR values were calculated using the formulas mentioned in the article (18). Considering that resection margins and chemotherapy may affect prognosis, we also performed sensitivity analysis after excluding patients with positive vertical resection margins and chemoradiotherapy, respectively.…”

Section: Methodsmentioning

confidence: 99%

Radiotherapy Improves Survival of Patients With Lymphovascular Invasion in pT1b Esophageal Squamous Cell Cancer After Endoscopic Submucosal Dissection

et al. 2023

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INTRODUCTION: Adjuvant radiotherapy is recommended for pT1b esophageal squamous cell cancer (ESCC) after endoscopic submucosal dissection (ESD). However, it is unclear whether additional radiotherapy can improve patient survival. This study aimed to evaluate the efficacy of adjuvant radiotherapy after ESD for pT1b ESCC. METHODS:This was a multicenter, cross-sectional study involving 11 hospitals in China. Between January 2010 and December 2019, patients with T1bN0M0 ESCC treated with or without adjuvant radiotherapy after ESD were included. Survival between groups was compared. RESULTS:Overall, 774 patients were screened, and 161 patients were included. Forty-seven patients (29.2%) received adjuvant radiotherapy after ESD (RT group) and 114 (70.8%) underwent ESD alone (non-RT group). There were no significant differences in overall survival (OS) and disease-free survival (DFS) between the RT and non-RT groups. Lymphovascular invasion (LVI) was the only prognostic factor. In the LVI1 group, adjuvant radiotherapy significantly improved survival (5-year OS: 91.7% vs 59.5%, P 5 0.050; 5-year DFS: 92.9% vs 42.6%, P 5 0.010). In the LVI2 group, adjuvant radiotherapy did not improve survival (5-year OS: 83.5% vs 93.9%, P 5 0.148; 5-year DFS: 84.2% vs 84.7%, P 5 0.907).The standardized mortality ratios were 1.52 (95% confidence interval 0.04-8.45) in the LVI1 group with radiotherapy and 0.55 (95% confidence interval 0.15-1.42) in the LVI2 group without radiotherapy. DISCUSSION:Adjuvant radiotherapy could improve survival in pT1b ESCC with LVI1 other than LVI2 after ESD. Selective adjuvant radiotherapy based on LVI status achieved survival rates similar to those of the general population.

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“…6 In a recent publication of AGA, for patients with ESCC with a pT1a-M3/pT1b-SM1 lesion, which is considered as non-curative resection, who are unfit for esophagectomy, they recommend a multidisciplinary review and close follow-up by EGD/EUS and CT scan. 9 If ESD is non-curative due to a positive lateral margin, repeat endoscopic resection or ablation with Argon plasma Coagulation/Radio Frequency Ablation (RFA)/Photodynamic Therapy (PDT)/ Cryotherapy can be considered. 15 These ablation options for post-ESD management are substantial advantages in the US compared with Japan.…”

Section: Post-esd Evaluation (Based On Guidelines) For Esccmentioning

confidence: 99%

How Do I Do It—ESD for ESCC

Nishimura

2022

Foregut: The Journal of the American Foregut Society

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Endoscopic submucosal dissection (ESD) has gained popularity in recent decades as a reliable and curative resection technique for early gastrointestinal tract neoplasms worldwide. Recent advances in multiple devices have enabled ESD to be a more accessible and safer procedure in the US. For esophageal ESD, it is crucial to expand our knowledge of the differences between esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). This article describes the diagnosis, ESD devices/techniques, and post-ESD management for ESCC.

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Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study

Cited by 22 publications

References 36 publications

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

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

Radiotherapy Improves Survival of Patients With Lymphovascular Invasion in pT1b Esophageal Squamous Cell Cancer After Endoscopic Submucosal Dissection

How Do I Do It—ESD for ESCC

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