Abstract
Background and AimEndoscopic submucosal dissection (ESD) sometimes results in en bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. The specific risk for such situations is unclear. We therefore investigated the outcome of ESD with HM1 or HMX.MethodsThis single‐center retrospective study was performed at Osaka International Cancer Institute. A total of 886 esophageal squamous cell carcinoma lesions in 749 patients treated from April 2005 to June 2015 were evaluated according to the following inclusion criteria: en bloc resection with no residual lesion, HM1 or HMX status, no prior treatment, and no additional treatment. We classified HM1 and HMX into type A, in which cancer was exposed on the HM, and type B, in which the HM status was unclear because of mechanical or thermal damage. We further classified type B according to the distance between the cancer and the edge of the specimen: type B1, <1 mm and type B2, ≥1 mm.ResultsThe resection margin was judged as HM1 or HMX in 5.0% (39/767; 95% confidence interval, 3.5–6.6%) of the en bloc resected specimens. Of 39 lesions, 30 fulfilled the inclusion criteria. Local recurrence developed in 8 of 30 lesions (26.7%). The local recurrence rates for types A, B1, and B2 were 40% (6/15 lesions), 28.5% (2/7 lesions), and 0.0% (0/8 lesions), respectively.ConclusionsAlthough a statistical analysis was not conducted because of the limited events, the pathological HM status may be a useful predictor of local recurrence.
Highlights
Esophageal cancer is the sixth most common cause of cancerrelated mortality worldwide.[1]
From April 2005 to June 2015, a total of 886 esophageal SCC (ESCC) lesions in 749 patients were treated by Endoscopic submucosal dissection (ESD)
ESD can theoretically achieve en bloc resection with an horizontal margin (HM)-negative status in all cases
Summary
Esophageal cancer is the sixth most common cause of cancerrelated mortality worldwide.[1]. Endoscopic mucosal resection (EMR) was initially developed and applied to the treatment of early-stage gastrointestinal cancer.[7]. Despite its efficacy, this method is sometimes associated with local recurrence or inconclusive histological results, especially when lesions of >20 mm are resected in a piecemeal manner.[8,9]. Endoscopic submucosal dissection (ESD) sometimes results in en bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. A total of 886 esophageal squamous cell carcinoma lesions in 749 patients treated from April 2005 to June 2015 were evaluated according to the following inclusion criteria: en bloc resection with no residual lesion, HM1 or HMX status, no prior treatment, and no additional treatment. Conclusions: a statistical analysis was not conducted because of the limited events, the pathological HM status may be a useful predictor of local recurrence
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