Endoscopy 2020; 52(11): 967-975
DOI: 10.1055/a-1185-9329
Original article

Long-term outcome of endoscopic resection for intramucosal esophageal squamous cell cancer: a secondary analysis of the Japan Esophageal Cohort study

Ichiro Oda
 1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Yuichi Shimizu
 2   Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
Toshiyuki Yoshio
 3   Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
 4   Department of gastroenterology, National Hospital Organization Osaka National Hospital, Osaka, Japan
Chikatoshi Katada
 5   Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
Tetsuji Yokoyama
 6   Department of Health Promotion, National Institute of Public Health, Wako, Japan
Tomonori Yano
 7   Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
Haruhisa Suzuki
 1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Satoshi Abiko
 8   Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Kenichi Takemura
 9   Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
Tomoyuki Koike
10   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
Kohei Takizawa
11   Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
Motohiro Hirao
12   Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
Hiroyuki Okada
13   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Takako Yoshii
14   Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
Atsushi Katagiri
15   Department of Medicine, Division of Gastroenterology, Showa University Hospital, Tokyo, Japan
Takenori Yamanouchi
16   Department of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan
Yasumasa Matsuo
17   Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
Hirofumi Kawakubo
18   Department of Endoscopy Center, Kawasaki Municipal Hospital, Kawasaki, Japan
Nozomu Kobayashi
19   Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
Tadakazu Shimoda
20   Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan
Atsushi Ochiai
21   Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan
Hideki Ishikawa
22   Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
Akira Yokoyama
23   Clinical Research Unit, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
Manabu Muto
24   Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
› Author Affiliations
Trial Registration: UMIN Clinical Trials RegistryRegistration number (trial ID): UMIN000001676 Type of study: prospective, multi-center study


Background Prospectively collected long-term data of patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma (ESCC) are limited. The aim of this study was to determine the prospectively collected long-term outcomes of endoscopic resection for ESCC as a secondary analysis of the Japan Esophageal Cohort (JEC) study.

Methods Patients who underwent endoscopic resection of intramucosal ESCC at 16 institutions between September 2005 and May 2010 were enrolled in the JEC study. All patients underwent endoscopic examination with iodine staining at 3 and 6 months after resection, and every 6 months thereafter. We investigated clinical courses after endoscopic resection, survival rates, and cumulative incidence of metachronous ESCC.

Results 330 patients (mean age 67.0 years) with 396 lesions (mean size 20.4 mm) were included in the analysis. Lesions were diagnosed as high-grade intraepithelial neoplasia in 17.4 % and as squamous cell carcinoma in 82.6 % (limited to epithelium in 28.4 %, to lamina propria in 55.4 %, and to muscularis mucosa in 16.2 %). En bloc resection was achieved in 291 (73.5 %). The median follow-up period was 49.4 months. Local recurrences occurred in 13 patients (3.9 %) and were treated by endoscopic procedures. Lymph node metastasis occurred in two patients (0.6 %) after endoscopic resection. The 5-year overall, disease-specific, and metastasis-free survival rates were 95.1 %, 99.1 %, and 94.6 %, respectively. The 5-year cumulative incidence rate of metachronous ESCC was 25.7 %.

Conclusions Our study demonstrated that endoscopic resection is an effective treatment for intramucosal ESCC, with favorable long-term outcomes.

Supplementary material

Publication History

Received: 15 January 2020

Accepted: 06 May 2020

Article published online:
24 June 2020

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