Long Term Prognosis of ESD for the Superficial Esophageal Squamous Cell Carcinoma

Abstract

Introduction: Lymph node metastasis (LNM) of esophageal squamous cell carcinoma (SCC) has been reported to correlate closely with the invasion depth and lymph duct involvement. When the invasion depth was intraepitheliam (m1) or proper mucosa (m2), the LNM has been reported 0 %. When SCC contacted with muscularis mucosa (m3) or invaded to submucosal layer 200 micrometer or less (sm1), the LNM is 9 to 20%. Therefore, the Japanese Esophageal Association decided the standard and expanding indication of esophageal EMR as the lesions those invasion depth is m1 or m2 and m3 or sm1, respectively. En bloc resection is necessary for the precise pathological examination. Therefore, endoscopic submucosal dissection (ESD) was developed. However, the long term prognosis after esophageal ESD is obscure. Aims & Methods: The aim of this study is to analyze the outcome of esophageal SCC treated by ESD and clarify the long term prognosis after esophageal ESD. 177 SCC in 158 patients were treated by ESD from Jan. 2000 to Oct. 2006 at Saku Central Hospital. The median age and observation period was 68 (44-86) and 32 months (4-90). The patients were divided into three groups due to the invasion depth; m1-2, m3-sm1 and sm2-3. M1 or m2 patients were followed up by Endoscopy and CT scan once a year. M3 or deep were recommended to be treated by esophagectomy with lymph node dissection or chemo radio therapy (CRT). If the patients refused the additional treatment, they were followed up by endoscopy and CT scan, twice a year. 176 of 177 patients were followed up in this study. Result of ESD1. Complete resection : 94%. 2. Median tumor and resected size was 24 mm (3 - 65) and 38 mm (12-73).3. Complications: Perforation 0%, Delayed perforation 0.6%, Mediastinal emphysema 4.5% (8/177) and Stricture 7.3% (13/177) . 4. Local recurrence was 0%. Prognosis of ESD1. M1 or m2 group, n = 111. The median age and observation period was 68 (44-82) and 32 months (4-90). 9 patients died of other diseases. 2. M3 or sm1 group, n = 39The median age and observation period was 67 (50-82) and 32 months (4-90). 8 patients agreed to be treated with CRT. 4 patients died of other diseases. 3. Sm2 group, n = 7The median age and observation period was 72 (65-79) and 42 months (14-50). Four of seven patients were treated by CRT. All patients are living without recurrence. Conclusions: The complete resection rate of the esophageal ESD was 94% and there were no severe complications. The local recurrent rate was 0% and no patients died of esophageal cancer. ESD is a difficult but useful method for the treatment of superficial esophageal SCC.