Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

Ching-Tai Lee,Ming-Hung Hsu,Wen-Lun Wang,Chi-Ming Tai,Hsiu-Po Wang,Tzu-Haw Chen

doi:10.1186/s12876-021-01888-1

Abstract

BackgroundEndoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan.MethodWe consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival.ResultsTotal of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC.ConclusionESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.

Highlights

Esophageal cancer has high mortality rate and an increased incidence in some areas, especially Asia and Eastern Africa
Betel nut chewers, and cigarette smokers were defined as those consuming any alcoholic beverage during the week, those who had chewed more than seven betel nuts per week, and those who smoked more than 10 cigarettes per week for at least 6 months, respectively [15]
The pattern of Lugol chromoendoscopy over the esophageal background mucosa was classified into four categories: type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs, based on the criteria proposed by Muto and colleagues [16]

Summary

Introduction

Esophageal cancer has high mortality rate and an increased incidence in some areas, especially Asia and Eastern Africa. The early detection and characterization of esophageal squamous cell carcinoma (ESCC) have ameliorated in recent years due to improvements in endoscopic technology such as image-enhanced. The 5-year overall, disease-specific and recurrence-free survival rates of ESD were 87.3%, 97.7% and 85.1%, respectively [14]. Few studies except for Japan have reported the long-term outcomes of SESCC after ESD. The aims of this study were to assess the longterm outcomes of ESD for the treatment of SESCC in the largest reported cohort in Taiwan, and to determine the risk factors for metachronous recurrence. Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superfi‐ cial esophageal squamous cell carcinoma (SESCC), the long-term outcomes have hardly ever been reported outside Japan

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