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.
