Clinical Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma of the Esophagogastric Junction.

Abstract

Endoscopic submucosal dissection (ESD) for adenocarcinoma in the esophagogastric junction (EGJ) is a technically difficult procedure. We analyzed the long-term clinical outcomes of ESD for adenocarcinoma in the EGJ to determine the feasibility of this treatment approach. Subjects who underwent ESD for Siewert type II adenocarcinoma between December 2004 and December 2011 were eligible for this study. Clinical features and treatment outcomes were retrospectively reviewed using medical records. A total of 88 subjects underwent ESD at our institute. The median patient age was 66years (interquartile range [IQR] 59-71years), and the male-to-female ratio was 10.0:1. The median tumor diameter was 20mm (IQR 14-25mm), and the median procedure time was 40min (IQR 30-60min). Adverse events occurred in nine patients (10.2%), namely bleeding (n=6) and suspicious microperforation (n=3). En bloc, complete, and curative resection rates were 88.6% (78/88), 83.0% (73/88), and 60.2% (53/88), respectively. In multivariate analysis, undifferentiated histology (P=0.009) and elevated lesions (P=0.011) were factors associated with noncurative resection. During a median follow-up period of 68.5months, local tumor recurrence was detected in two patients (2.4%), and the 5-year overall and disease-specific survival rates were 96.6 and 100.0%, respectively. ESD for the treatment of EGJ cancer may be an effective and safe treatment strategy based on favorable long-term outcomes.