全周性cT1aN0M0食道扁平上皮癌に対する内視鏡的粘膜下層剥離術後の長期予後

Endoscopic submucosal dissection (ESD) is the standard treatment for cT1a esophageal squamous cell carcinoma (ESCC); however, its indication for the entire circumferential lesion remains controversial because of the stricture risk after ESD. Therefore, several treatments are administered based on 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 rates to chemoradiotherapy were evaluated.

Of the 59 eligible patients, 28/15/16 patients received ESD/chemoradiotherapy/esophagectomy 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 complete response rate to chemoradiotherapy was 94%.

The long-term outcomes of each treatment group for entire circumferential 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.