Long-term results of endoscopic mucosectomy for early esophageal cancer

Introduction: In Hungary most of esophageal tumors detected at the stage of T2-T4. Chance to recognize an early cancer usually offers at control examinations for Barrett esophagus and for esophageal varices, or at examinations for suspicion of GERD.

Patients and method: Endoscopic mucosal resection was performed in 8 patients with early esophageal cancers between 2002 and 2008. By endoscopic ultrasound carried out before the procedure neither submucosal spreading of the tumor, nor pathological regional lymph nodes were detected. The indication of endoscopic mucosectomy was the high risk of the surgical treatment because of age, severe co-morbidity, etc. The “lift and cut“ technique was used for resection. There were no early complications; the histological evaluation showed total excision in all cases. After the procedure – except in case of contraindication – patients have undergone adjuvant oncological treatment.

Results: Five of the 8 patients are still alive free of tumor. Two patients died because of independent reasons from diseases. The average disease free survival is 31 months.

Discussion: Owing to the development of endoscopic ablative therapy the endoscopic submucosal dissection takes the place of mucosectomy, because it ensures more safety vertical and horizontal resection surface. Therefore better survival results could be expected. Based on the favorable results, endoscopic ablative therapy considers curative treatment for early esophageal cancer; it is alternative of surgical intervention, not only for high risk patients.