Long-term outcome after endoscopic submucosal dissection for entire circumferential cT1aN0M0 esophageal squamous cell...

Endoscopic submucosal dissection (ESD) is the standard treatment for cT1a esophageal squamous cell carcinoma (ESCC); however, its indication for the entire circumferential (EC) lesion remains controversial because of the stricture risk after ESD. Therefore, several treatments are administered on the basis of the physician's choice; the clinical course, however, remains unclear. This retrospective study aimed to clarify the long-term outcomes after ESD in patients with circumferential cT1aN0M0 ESCC compared with those after esophagectomy or chemoradiotherapy.

Patients with circumferential cT1aN0M0 ESCC treated with ESD, chemoradiotherapy, or esophagectomy as the initial treatment between January 2010 and December 2018 were included. The 5-year overall survival (OS), 5-year disease-free survival (DFS), esophageal stricture, refractory stricture, curative ESD resection, and complete response (CR) rates to chemoradiotherapy were evaluated.

Of the 59 eligible patients, 28, 15, and 16 patients received ESD, chemoradiotherapy, and esophagectomy, respectively, as the initial treatment. During a median follow-up period of 95 months, the 5-year OS/DFS was 93%/89% after ESD, 87%/87% after esophagectomy, and 75%/69% after chemoradiotherapy. The curative resection rate of ESD was 72%. The esophageal stricture/refractory stricture rates were 79%/46% after ESD, 20%/13% after esophagectomy, and 0%/0% after chemoradiotherapy. The CR rate to chemoradiotherapy was 94%.

The long-term outcomes of each treatment group for EC cT1aN0M0 ESCC were elucidated. The esophageal stricture and refractory stricture rates after ESD were higher than those in other patients. Further investigations in large cohorts are necessary to clarify the indication criteria for ESD in patients with lesions.