Long-Term Outcomes of Patients with Superficial Esophageal Squamous Cell Carcinoma After Endoscopic Mucosal Resection (EMR)

Abstract

Background: Superficial esophageal squamous cell carcinomas (ESCCs) are tumors within the esophageal epithelium (EP), lamina propria (LPM), or muscularis mucosa (MM). The EP and LPM cancers are good candidates for EMR, as the prognosis for these patients is excellent. In previous reports, however, lymph node metastases were found in 10%-15% of the MM cancer patients who underwent radical esophagectomy, thus the suitability of EMR in patients with MM cancer is less clear. The aim of this retrospective analysis was to clarify the long-term outcomes after EMR in patients with superficial ESCCs, including MM cancers. Patients and Method: Patients were identified from our database on the basis of the following criteria: histologically confirmed ESCC in the EMR specimens; no prior therapy for ESCC; no prior chemotherapy for other malignancies; and patients who were followed-up for at least 1 year after EMR with repeated examinations in 3-month to 1-year intervals. If patients had lymphatic or vessel infiltration, esophagectomy or chemoradiotherapy were recommended as additional treatments. Results: Between February 1998 and June 2004, 241 consecutive patients with 282 lesions fulfilled the criteria. The numbers of EP, LPM, and MM cancers were 133, 77, and 72 lesions, respectively. Lymphatic or vessel infiltration was found in one patient with LPM cancer and four patients with MM cancers. Although during treatment esophageal perforation and bleeding occurred in two and one patients respectively, no patients underwent urgent surgery. At a median follow-up period of 50 months (range: 12 to 156 months), local recurrence and regional lymph node and distant metastasis were found in 48, 2, and 1 patient. One patient with MM cancer had distant metastases; he was treated with chemotherapy, but died of ESCC. The 5-year overall and cause-specific survival rates were 90% and 99%, respectively. The survival of patients with EP and LPM cancers (90%) and of those with MM cancers (89.5%) were not different (Log-rank test, p = 0.72). Conclusions: The overall survival of patients with superficial ESCCs in whom EMR was performed was excellent. However, these patients, especially with MM cancer, should be monitored by constant careful surveillance with periodic examinations by not only Lugol chromoendoscopy, but also neck, chest, and abdominal computed tomography because of the risk of lymph node and distant metastases.