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Long-Term Follow-Up After Non-Curative Endoscopic Submucosal Dissection for Early Gastrointestinal Cancer-A

Philipp Pimingstorfer1,2, Matus Gregus3, Alexander Ziachehabi3

  • 1University Clinic for Internal Medicine 2, Kepler University Clinic, 4020 Linz, Austria.

Journal of Clinical Medicine
|November 9, 2024
PubMed
Summary

Endoscopic Submucosal Dissection (ESD) for early gastrointestinal cancers can be non-curative. While recurrence is higher after non-curative ESD, surgery is often not advised for elderly or comorbid patients due to high non-oncological mortality.

Keywords:
ESDnon-curativenon-curative ESD

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Endoscopic Procedures

Background:

  • Endoscopic Submucosal Dissection (ESD) is standard for early GI cancers, offering oncological outcomes comparable to surgery.
  • A significant portion of ESDs (approx. 30%) do not achieve curative resection, necessitating further treatment.
  • Many patients eligible for surgery due to non-curative ESD are poor surgical candidates due to comorbidities or advanced age.

Purpose of the Study:

  • To evaluate the long-term outcomes of patients who underwent non-curative Endoscopic Submucosal Dissection (ncESD) without additional therapy.
  • To compare the recurrence and mortality rates between patients treated with ncESD and those with curative ESD (cESD).

Main Methods:

  • A multicenter retrospective cohort study analyzed data from 2009 to May 2024.
  • Outcomes were compared between ncESD and cESD cohorts, focusing on malignancy recurrence (local or lymph node metastasis) and death.
  • Follow-up data was collected for patients who did not receive additional tumor therapy post-ESD.

Main Results:

  • The study analyzed 374 ESD procedures with a 91% technical success rate; 70.9% met curative resection criteria.
  • In the ncESD group (n=35), 20% experienced recurrence, primarily due to positive horizontal margins. 3 patients died from non-oncological causes.
  • The cESD group (n=33) had a 3% recurrence rate and one non-oncological death. Tumor recurrence was significantly higher in the ncESD cohort (p=0.017).

Conclusions:

  • Managing elderly and multimorbid patients after ncESD is challenging, with surgery often not recommended.
  • Rates of residual malignancy and cancer recurrence after ncESD are low, but non-oncological mortality is high in this patient group.
  • Further research is needed to personalize management strategies for patients following non-curative ESD.