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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(04): E396-E402
DOI: 10.1055/a-0838-5064
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Clinical feasibility of endoscopic submucosal dissection with minimum lateral margin of superficial esophageal squamous cell carcinoma

Hiroki Kuwabara
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
2   Omori Red Cross Hospital, Department of Gastroenterology, Tokyo, Japan
,
Seiichiro Abe
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
,
Satoru Nonaka
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
,
Haruhisa Suzuki
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
,
Shigetaka Yoshinaga
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
,
Ichiro Oda
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
,
Yutaka Saito
1   National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 01 June 2018

accepted after revision 26 November 2018

Publication Date:
15 March 2019 (online)

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Abstract

Background Esophageal stricture following endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell cancer (SESCC) has been associated with wide mucosal defects greater than three-quarters of the luminal circumference. Some patients developed dysphagia and required repeated endoscopic balloon dilation even after steroid therapy. As iodine staining clearly visualized the margin of SESCC, we made a longitudinal mucosal incision close to the margin of the lesion to avoid a mucosal defect involving over three-quarters of the luminal circumference for large lesions. This retrospective study aimed to clarify the clinical feasibility of ESD with minimum lateral margin of SESCC.

Patients and methods Between 2005 and 2013, 94 patients with 94 initial SESCCs had lesions greater than half of the luminal circumference. Of those, 70 patients with 70 SESCCs had achieved endoscopic clearance for the initial SESCC. In this study, endoscopic clearance was defined as en bloc resection of SESCC histologically confined to the mucosa without lymphovascular invasion and with a free deep margin regardless of the lateral margin. This study evaluated the short- and long-term outcomes in patients undergoing endoscopic clearance.

Results In total, 61.4 % (43/70) of the patients had mucosal defects involving over three-quarters of the luminal circumference and 38.5 % (27/70) had a positive or indeterminate lateral margin. However, there was no local or nodal recurrence during the median follow-up period of 3.8 years; the 3-year overall survival rate was 98.5 % and the 3-year disease-free survival rate was 100 %.

Conclusion Using our institutions’ strategy, ESD for SESCCs with minimum lateral margins was oncologically acceptable; this approach could reduce the known risk factor of post-ESD stricture.

 

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