Tu1177 ENDOSCOPIC RESECTION IS THE APPROPRIATE TREATMENT CHOICE FOR MM INVASIVE ESOPHAGEAL SCC

Abstract

Recent advances in endoscopic resection (ER) provide us increasing chances for resecting esophageal SCC with muscularis mucosae (MM) invasion. For them, we perform additional therapy such as chemo radiotherapy (CRT) or operation considering the risk of metastasis and patients’ condition. However, there is only a few reports of long term outcome comparing ER and operation, which is the standard treatment for MM invasive esophageal SCC. We retrospectively studied the long-term outcome in 134 cases of esophageal SCC with pathological MM invasion resected by ER (99 cases) and operation (35 cases) from 2003 to 2014 in Cancer Institute Hospital. Median observation period was 62 months for ER cases and 50 months for operation cases. Median age for ER and operation cases were 66 and 64. Median lesion size in ER cases were significantly smaller than that in operation cases (24mm vs 44mm, P<0.01). Lymphovascular invasion were observed 14% in ER cases and 26% in operation cases. It was implicated that operation cases were more advanced cancer, although pathological depth of invasion was both MM. Of 99 cases of ER, 79 cases were observed without additional treatment. One case had recurrence as LN metastasis, received operation and CRT, and survived with no re-recurrence. The rest of 20 cases were recommended additional therapy because of lymphovascular invasion or droplet infiltration and 12 cases were performed additional therapy (operation/CRT/RT 7/4/1). Of 35 cases of operation, one case had recurrence and resected additionally. No one died of Esophageal SCC in both groups. Overall survival rate in 3 year/5 year were 90.8%/89.4% in ER cases and 88.6%/81.2% in operation cases. Cause specific survival rate in 3 year/5 year were 100%/100% in both ER cases and operation cases. The long-term outcome of ER for MM invasive esophageal SCC was good enough with appropriate additional therapy. ER will be a good and appropriate treatment choice for MM invasive esophageal SCC.