Endoscopy 2019; 51(04): 298-306
DOI: 10.1055/a-0732-5317
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Long-term follow-up after endoscopic resection for superficial esophageal squamous cell carcinoma: a multicenter Western study

Arthur Berger*
1  Department of Hepatology and Gastroenterology, Angers University, Angers Teaching Hospital, Angers, France
,
Gabriel Rahmi*
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
Guillaume Perrod
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
Mathieu Pioche
3  Department of Hepatology and Gastroenterology, Lyon 1 University Claude Bernard, Edouard Herriot hospital, Lyon, France
,
Jean-Marc Canard
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
4  Department of Hepatogastroenterology, Trocadero Private Hospital, Paris, France
,
Elodie Cesbron-Métivier
1  Department of Hepatology and Gastroenterology, Angers University, Angers Teaching Hospital, Angers, France
,
Jérôme Boursier
1  Department of Hepatology and Gastroenterology, Angers University, Angers Teaching Hospital, Angers, France
,
Elia Samaha
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
Ariane Vienne
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
,
Vincent Lépilliez
5  Department of Hepatogastroenterology, Mermoz Private Hospital, Lyon, France
,
Christophe Cellier
2  Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
› Author Affiliations
Further Information

Publication History

submitted 26 November 2017

accepted after revision 25 July 2018

Publication Date:
27 September 2018 (eFirst)

Abstract

Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the first-line treatments for superficial esophageal squamous cell carcinoma (SCC). This study aimed to compare long-term clinical outcome and oncological clearance between EMR and ESD for the treatment of superficial esophageal SCC.

Methods We conducted a retrospective multicenter study in five French tertiary care hospitals. Patients treated by EMR or ESD for histologically proven superficial esophageal SCC were included consecutively.

Results Resection was performed for 148 tumors (80 EMR, 68 ESD) in 132 patients. The curative resection rate was 21.3 % in the EMR group and 73.5 % in the ESD group (P < 0.001). The recurrence rate was 23.7 % in the EMR group and 2.9 % in the ESD group (P = 0.002). The 5-year recurrence-free survival rate was 73.4 % in the EMR group and 95.2 % in the ESD group (P = 0.002). Independent factors for cancer recurrence were resection by EMR (hazard ratio [HR] 16.89, P = 0.01), tumor infiltration depth ≥ m3 (HR 3.28, P = 0.02), no complementary treatment by chemoradiotherapy (HR 7.04, P = 0.04), and no curative resection (HR 11.75, P = 0.01). Risk of metastasis strongly increased in patients with tumor infiltration depth ≥ m3, and without complementary chemoradiotherapy (P = 0.02).

Conclusion Endoscopic resection of superficial esophageal SCC was safe and efficient. Because it was associated with an increased recurrence-free survival rate, ESD should be preferred over EMR. For tumors with infiltration depths ≥ m3, chemoradiotherapy reduced the risk of nodal or distal metastasis.

* These authors contributed equally to this work.


Supplementary Table e2, Table e5, Table e6, Fig. e3 and Fig. e4