Endoscopic submucosal dissection for early esophageal squamous cell carcinoma: long-term results from a Western cohort

Abstract

Background Although endoscopic submucosal dissection (ESD) is established as first-choice treatment for early esophageal squamous cell carcinoma (ESCC) worldwide, most data are derived from Asian studies. We aimed to evaluate the long-term outcomes of ESD for patients with early ESCC in a Western cohort.

Methods In this retrospective cohort study, patients with early ESCC amenable to ESD were included from four tertiary referral hospitals in the Netherlands between 2012 and 2017. All ESD procedures were performed by experienced endoscopists, after which the decision for additional treatment was made on a per-patient basis. Outcomes were curative resection rate, ESCC-specific survival, and overall survival.

Results Of 68 included patients (mean age 69 years; 34 males), ESD was technically successful in 66 (97%; 95%CI 93%–100%), with curative resection achieved in 34/66 (52%; 95%CI 39%–64%). Among patients with noncurative resection, 15/32 (47%) underwent additional treatment, mainly esophagectomy (n = 10) or definitive chemoradiation therapy (n = 4). Endoscopic surveillance was preferred in 17/32 patients (53%), based on severe comorbidities or patient choice. Overall, 31/66 patients (47%) died during a median follow-up of 66 months; 8/31 (26%) were ESCC-related deaths. The 5-year overall and ESCC-specific survival probabilities were 62% (95%CI 52%–75%) and 86% (95%CI 77%–96%), respectively.

Conclusion In this Western cohort with long-term follow-up, the effectiveness and safety of ESD for early ESCC was confirmed, although the rate of noncurative resections was substantial. Irrespective of curative status, the long-term prognosis of these patients was limited mainly due to competing mortality.

Publication History

Received: 18 July 2023

Accepted after revision: 23 December 2023

Article published online:
07 February 2024

• References

• 1 Sung H, Ferlay J, Siegel ME. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71: 209-249 DOI: 10.3322/caac.21660. (PMID: 33538338)
• 2 Morgan E, Soerjomataram I, Rumgay H. et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology 2022; 163: 649-658
• 3 Abnet CC, Arnold M, Wei W-Q. Epidemiology of esophageal squamous cell carcinoma. Gastroenterology 2018; 154: 360-373 DOI: 10.1053/j.gastro.2017.08.023. (PMID: 28823862)
• 4 Kitagawa Y, Uno T, Oyama T. et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus 2019; 16: 1-24 DOI: 10.1007/s10388-018-0642-8. (PMID: 30171414)
• 5 Ishihara R, Arima M, Iizuka T. et al. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc 2020; 32: 452-493 DOI: 10.1111/den.13654. (PMID: 32072683)
• 6 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622 DOI: 10.1055/a-1811-7025. (PMID: 35523224)
• 7 Eguchi T, Nakanishi Y, Shimoda T. et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol 2006; 19: 475-480 DOI: 10.1038/modpathol.3800557. (PMID: 16444191)
• 8 Endo M, Yoshino K, Kawano K. et al. Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus 2000; 13: 125-129 DOI: 10.1046/j.1442-2050.2000.00100.x. (PMID: 14601903)
• 9 Shimada H, Nabeya Y, Matsubara H. et al. Prediction of lymph node status in patients with superficial esophageal carcinoma: analysis of 160 surgically resected cancers. Am J Surg 2006; 191: 250-254
• 10 Li B, Chen H, Xiang J. et al. Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 2013; 146: 1198-1203 DOI: 10.1016/j.jtcvs.2013.07.006. (PMID: 23988285)
• 11 Bollschweiler E, Baldus SE, Schröder W. et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 2006; 38: 149-156
• 12 Takahashi H, Arimura Y, Masao H. et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 2010; 72: 255-264
• 13 Ono S, Fujishiro M, Niimi K. et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 2009; 70: 860-866 DOI: 10.1016/j.gie.2009.04.044. (PMID: 19577748)
• 14 Kim JS, Kim B-W, Shin I. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci 2014; 59: 1862-1869 DOI: 10.1007/s10620-014-3098-2. (PMID: 24619279)
• 15 Probst A, Ebigbo A, Eser S. et al. Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma: long-term follow-up in a Western center. Clin Endosc 2023; 56: 55-64 DOI: 10.5946/ce.2022.093. (PMID: 36634965)
• 16 Liu Y, Qian D, Tang B. et al. Feasibility of endoscopic submucosal dissection for early esophageal squamous cell carcinoma with relative indications. Dig Surg 2021; 38: 14-23
• 17 Nagami Y, Ominami M, Shiba M. et al. The five-year survival rate after endoscopic submucosal dissection for superficial esophageal squamous cell neoplasia. Dig Liver Dis 2017; 49: 427-433 DOI: 10.1016/j.dld.2016.12.009. (PMID: 28096057)
• 18 Song BG, Min YW, Lee JH. et al. Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma. Surg Endosc 2017; 31: 3905-3911