[Endoscopic mucosal resection for esophageal cancer]

Area of Science:

• Gastroenterology
• Oncology
• Endoscopic Surgery

Context:

• Early esophageal cancers confined to the epithelium or lamina propria mucosae have rare lymph node metastasis.
• Endoscopic mucosal resection (EMR) is the recommended radical treatment for these early-stage cancers.
• Surgical resection was historically indicated for cancers reaching the muscularis mucosae due to a 10% lymph node metastasis rate.

Purpose:

• To evaluate the outcomes of endoscopic mucosal resection (EMR) for early esophageal cancers.
• To assess the incidence of local recurrence, metachronous esophageal cancer, and associated malignancies after EMR.
• To compare the prognosis of EMR with surgical treatment for specific early esophageal cancer stages.

Summary:

• Among 219 patients undergoing EMR for esophageal cancer (196 mucosal, 23 submucosal), 14% were lost to follow-up. Four patients died of esophageal cancer, while others succumbed to different diseases or cancers.
• Local recurrence occurred in 8.3% of EMR cases, primarily in those with piecemeal resection, and was often detected within one year via endoscopic surveillance.
• Metachronous esophageal cancers were found in 11% of EMR cases, frequently in patients with specific mucosal findings, and were often detected within 1-3 years.

Impact:

• EMR demonstrates a favorable prognosis for selected early esophageal cancers, comparable to surgery in some cases.
• Endoscopic surveillance is vital for early detection of local recurrence and metachronous esophageal cancers post-EMR.
• Associated synchronous and metachronous malignancies, particularly in the stomach and head/neck, warrant consideration in patients treated with EMR.