An extra 1-cm margin during endoscopic submucosal dissection can control subsquamous tumor extension of esophagogastric junction adenocarcinoma

Introduction

The incidence of esophagogastric junction (EGJ) adenocarcinoma has increased during recent decades, especially in Western countries. This is mainly related to the increasing prevalence of gastroesophageal reflux disease and obesity, and the decreasing prevalence of Helicobacter pylori infection. The incidence of EGJ adenocarcinoma is also increasing in Eastern countries, including Japan, and is expected to continue doing so for similar reasons. Endoscopic submucosal dissection (ESD) is a minimally invasive and curative treatment for superficial gastrointestinal cancer, as it provides a high rate of en bloc resection, regardless of lesion size, and facilitates accurate histopathological diagnosis [1]. Several retrospective studies have recently indicated that ESD is safe and effective for EGJ adenocarcinomas [2] [3] [4] [5] [6].

EGJ adenocarcinomas can extend laterally and invade the neighboring normal esophageal squamous epithelium; this is known as subsquamous tumor extension (STE) [7]. Because STE may not be observable at the esophageal epithelium, it is difficult to accurately define the proximal tumor margin during ESD for EGJ adenocarcinomas; this can lead to postoperative positive lateral margins [3] [5] [6]. In a previous study, we retrospectively showed that an extra 1-cm safety margin achieved 100 % negative lateral margins during ESD for EGJ adenocarcinomas, even when the STE was < 7 mm [4].

In response to the lack of prospectively collected data, the present prospective feasibility study aimed to evaluate whether considering an extra 1-cm safety margin was effective in preventing positive lateral margins during ESD for EGJ adenocarcinomas.

Publication History

Received: 19 February 2022

Accepted after revision: 01 September 2022

Accepted Manuscript online:
05 September 2022

Article published online:
15 November 2022

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