Endoscopy 2018; 50(04): S8-S9
DOI: 10.1055/s-0038-1637048
ESGE Days 2018 oral presentations
20.04.2018 – Upper GI: resection session 1
Georg Thieme Verlag KG Stuttgart · New York

MULTICENTRIC ASSESSMENT OF THE ENDOSCOPIC MANAGEMENT OF SUPERFICIAL ESOPHAGEAL SQUAMOUS-CELL CARCINOMA IN WESTERN POPULATION

A Berger
1   CHU Angers, Hepatogastro-Enterology, Angers, France
,
G Rahmi
2   Hopital Européen Georges Pompidou, Paris, France
,
G Perrod
2   Hopital Européen Georges Pompidou, Paris, France
,
M Pioche
3   Hopital Edouard Herriot, Lyon, France
,
JM Canard
4   Clinique du Trocadéro, Paris, France
,
E Cesbron-Métivier
5   CHU Angers, Angers, France
,
J Boursier
5   CHU Angers, Angers, France
,
E Samaha
2   Hopital Européen Georges Pompidou, Paris, France
,
A Vienne
2   Hopital Européen Georges Pompidou, Paris, France
,
V Lépilliez
6   Hopital Prive Jean Mermoz, Lyon, France
,
C Cellier
2   Hopital Européen Georges Pompidou, Paris, France
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Publikationsverlauf

Publikationsdatum:
27. März 2018 (online)

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Aims:

Evaluation of the endoscopic resection efficiency for superficial esophageal SCC and long-term outcom.

Methods:

We conducted a retrospective multicenter study in 5 french tertiary care hospitals. All patients treated by EMR or ESD for histologically proven SCC were consecutively included. Esophageal SCC were defined as superficial after macroscopic evaluation including Lugol staining and endoscopic ultrasonography (EUS). Curative resection was defined as pT1a with free resection margins, without lympho-vascular embols.

Results:

Between 1998 to 2016, 132 patients were enrolled and 148 tumors were resected (EMR = 80, ESD = 68). Mean tumor size was 15.0 mm in the EMR group and 35 mm in the ESD group (p < 0.001). The complete resection rate in the EMR and ESD groups were respectively 30% (24/80) and 100% (68/68) (p < 0.0001). The mean follow-up period was 22 months. The recurrence rate was 14.2% (19/80 in the EMR group and 2/68 in the ESD group, p = 0.001). Recurrence-free survival rate was 74.6% at 24 months. Factors associated with recurrence in univariate analysis were: tumors size (p = 0.013), resection by EMR (p = 0.001), piecemeal resection (p = 0.016), and microscopic positive margins (p = 0.044). In multivariate analysis, risks factors for recurrence were: resection by EMR (OR = 7.315; IC [1.685 – 31.762]; p = 0.008) and tumor deep infiltration ≥ m3 (OR = 2.635; IC [1.065 – 6.519]; p = 0,036). At 24 months, recurrence-free survival rate were 95.2% in ESD group, versus 59.8% in EMR group (p = 0.001). For infiltrating tumors ≥ m3, metastasis free survival rate at 24 motnhs were 100.0% after complementary treatment by radio-chemotherapy, and 62.2% without complementary treatment (p = 0.042).

Conclusions:

Endoscopic resection of superficial esophageal SCC is safe and efficient. According to our results, ESD should be preferred to EMR because it is associated with a higher curative rate and an increased recurrence free survival rate.