Aims Studies on the efficacy and prognosis of superficial esophageal squamous cell carcinoma
are rare in the Western World. Our aim was to analyse the results of endoscopic resection
combined, if indicated in high risk endoscopic resections, with surgery or chemoradiotherapy
(CRT).
Methods Retrospective review of a prospective endoscopic database, including demographic
data, comorbidities, previous treatments, type and size of lesion, technique of resection,
pathological assessment (horizontal and vertical margins, grade of differentiation,
lymphovascular invasion), “adjuvant” treatment, relapse rate, treatment of relapses,
and final outcome [1]
[2]
[3]
[4].
Results 283 lesions (ESD 218, EMR 65) were resected in 208 patients, 64% males, with a history
of alcohol in 75%, smoking in 71%, and ENT cancer in 25%. Lesions were located in
the upper mid and lower esophagus in 22, 56, 22% of patients, respectively. Mean size
of lesion was 25 mm (range: 3-100mm), and mean circumference of lesion 33% (range:
5-100%). Half of the interventions (139/283) had a previous treatment (ESD/EMR/CRT).
151 (53%) lesions were=<m2, 102 (36%) m3-sm1, 30 (10.6%) deeper. The resection was
R0 (vertical) in 248 (88%) and R0 (horizontal for cancer) in 251 (89%). Lymphovascular
invasion was observed in 32 (14%), G3 in 18 lesions (6.4%). R0 and curative resection
rates were therefore 87.6% and 44.9%, respectively. Lesions at high risk for recurrence
were calculated at 35% (99/283). However local recurrence was observed in only 19/208
patients (9.1%) and distant metastasis in 12/208 patients (5.7%), with a mean follow-up
of 56 months (4.7y). Indeed adjuvant treatment was proposed after MDT to 103 patients
and effectively achieved in 58 patients (18 surgery and 40 CRT or immunotherapy).
Complications of endoscopic resection were as follows: 1 bleeding (0.3%), 13 perforations
(4.6%), 73 strictures (25.8%), and mortality at 90days in 2 patients.
Conclusions Endoscopic resection for superficial esophageal squamous cell carcinoma seems a valid
proposal in Western countries, with low rates of local recurrence (9.1%), and distant
metastases (5.7%), when combined with surgery of CRT after multidisciplinary discussion,
in the high risk resections.
