食道扁平上皮癌に対する内視鏡的粘膜下層剥離術後の根治切除および非根治切除における長期予後の比較

Given the limited data on the long-term outcomes of non-curative resection (non-CR) following endoscopic submucosal dissection (ESD) for patients with superficial esophageal squamous cell carcinoma (SESCC), we compared the clinical outcomes of patients who did and did not achieve curative resection (CR).

This retrospective, single-center study reviewed data of patients with SESCC who underwent ESD at a tertiary referral center in Korea between 2011 and 2021. Non-CR was defined as the presence of any of the following: lymphovascular invasion, submucosal invasion, or positive vertical resection margin on ESD. Clinical outcomes and tumor-related characteristics were assessed.

Most patients (93.3%, 28/30) in the non-CR group underwent additional treatment, including 11 who underwent surgery and 17 who received radiotherapy, whereas no patients in the CR group required additional surgery or radiotherapy. During a median follow-up of 58 months, the cumulative rate of recurrence was 0.9% (1/108) in the CR group and 16.7% (5/30) in the non-CR group. The 5-year overall survival rate was higher in the CR group, although the between-group difference was not statistically significant (91.1% vs 82.3%, p=0.873). The 5-year recurrence-free survival rates were 98.7% and 83.2% for the CR and non-CR groups, respectively (p<0.001). The overall adverse event rates were similar between the two groups (16.7% vs 20.0%, p=0.878).

ESD followed by appropriate treatment can yield acceptable long-term outcomes, even when CR is not achieved. These findings suggest that ESD may be a viable first-line treatment strategy for SESCC, even in patients who are unlikely to achieve CR, particularly high-risk surgical patients.