Sa1290 LONG-TERM OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A COMPARISON STUDY TO SURGICAL COHORT

Abstract

Endoscopic submucosal dissection (ESD) is widely accepted treatment option for superficial esophageal squamous cell carcinoma (SESCC). But there are few studies that compare long-term outcomes of ESD with surgical result. Aim of this study was to compare overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) of ESD with those of surgery. We retrospectively reviewed patients who underwent ESD (n=71) or surgery (n=274) for pTis-pT1 SESCC in the Seoul National University Hospital from January 2005 to December 2017. Patients with pathologically confirmed SESCC that fulfilled the absolute or the relative indication of ESD were finally analyzed. Among 143 patients, 50 (35.0%) underwent ESD and 93 (65.0%) underwent esophagectomy. The ESD group showed higher proportion of the absolute indication (84.0% vs 48.3%), smaller tumor size (mean, 15.9mm vs 25.7mm), higher proportion of high grade dysplasia (64.0% vs 17.2%) and less invasive feature (M3 or SM1, 16.0% vs 51.6%) than the surgery group. The ESD group showed lower complication rates [14.0% (7 of 50) vs 49.5% (46 of 93), p<0.001], shorter hospital stay (mean, 3.2days vs 29.5days, p<0.001), and lower annual incidence of recurrence (0.57% vs 2.10%, p<0.001) than surgery group (Table 1). The Kaplan-Meier survival curves for OS, DSS and RFS also showed comparable long-term outcomes of the ESD group with those of the surgery group (OS, p=0.334; DSS, p=0.354; RFS, p=0.206)(Figure 1). Subgroup analysis was performed for one group that meeting the absolute indication and the other group that fulfilled the relative indication of ESD. No statistical significant differences of OS, DSS and RFS were suggested in subgroup analysis. Cox regression multivariate analysis for OS and RFS was done after adjustment for age, sex, comorbidity and the ESD indication. The adjusted hazard ratio (aHR) for OS and RFS in the ESD group were no significant difference compared with the surgery group [OS, aHR 0.396 (95% confidence interval (CI) 0.082-1.908), p=0.248; RFS, aHR 0.361 (95% CI 0.043-3.030), p=0.348]. Long-term outcomes of ESD comparable with surgery in patients with SESCC. In terms of complication and hospital stay, ESD is the better treatment option for SESCC than radical surgery. This results support ESD as an alternative to esophagectomy in SESCC.Figure 1Comparisons of long-term outcomes between the ESD group and the surgery group (Kaplan-Meier survival curve)View Large Image Figure ViewerDownload Hi-res image Download (PPT)