PREDICTORS OF FAILURE OF EN BLOC RESECTION OR PERFORATION IN ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL NEOPLASIA

Aims:

Endoscopic submucosal dissection (ESD) is accepted as the standard treatment for early-stage esophageal neoplasia. However, esophageal perforation may occur, leading to mediastinitis and pneumothorax, which sometimes require emergency surgery. In addition, failure of en bloc resection causes local recurrence. Until now, few studies have reported on predictors of failure of en bloc resection or perforation during ESD. Thus, we evaluated the predictors of failure of en bloc resection or perforation in ESD for esophageal neoplasia.

Methods:

This was a retrospective observational study conducted at a single institution. Between May 2004 and March 2016, 543 consecutive patients with 927 esophageal lesions were treated with ESD. Patients with metachronous esophageal neoplasia or missing data were excluded. The primary outcome was determining the predictors of failure of en bloc resection or perforation in patients who underwent esophageal ESD. Perforation was defined as a visible hole in the esophageal wall, exposing the mediastinal cavity.

Results:

A total of 543 patients with 736 lesions were evaluated. Failure of en bloc resection occurred in 6 patients (1.1%) with 6 lesions, and perforation occurred in 11 patients (2.0%) with 11 lesions (1.5%). Lesion diameter [odds ratio (OR), 1.05; 95% confidence interval (CI): 1.02 – 1.07; p < 0.001)], wider tumor circumference (OR, 9.80, 95% CI: 1.61 – 59.5; p= 0.01), and previous chemoradiotherapy for esophageal cancer (OR, 3.87; 95% CI: 1.19 – 12.53; p= 0.02) were associated with failure of en bloc resection or perforation according to crude logistic regression analysis. Multivariate logistic regression analysis showed that lesion diameter (OR, 1.04; 95% CI: 1.02 – 1.06; p < 0.001) and previous chemoradiotherapy (OR, 5.24; 95% CI: 1.52 – 18.06; p = 0.009) were independent predictive factors.

Conclusions:

Larger lesions and previous chemoradiotherapy for esophageal cancer increased the risk of failure of en bloc resection or perforation in patients who underwent esophageal ESD.