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. 2021 Feb;35(2):593-601.
doi: 10.1007/s00464-020-07420-y. Epub 2020 Feb 18.

The possibility of endoscopic treatment of cN0 submucosal esophageal cancer: results from a surgical cohort

Bo Ye #  1 , Xiaobin Zhang #  1 , Yuchen Su  1 , Shuguang Hao  2 , Haohua Teng  3 , Xufeng Guo  1 , Yu Yang  1 , Yifeng Sun  1 , Teng Mao  1 , Zhigang Li  4
Affiliations

The possibility of endoscopic treatment of cN0 submucosal esophageal cancer: results from a surgical cohort

Bo Ye et al. Surg Endosc. 2021 Feb.

Abstract

Background: We analyzed the pathological characteristics and recurrence pattern of cN0 submucosal esophageal cancer after esophagectomy and conducted risk stratification to determine the feasibility of performing endoscopic resection for cN0pT1b esophageal squamous cell malignancies.

Methods: We retrospectively enrolled 167 patients who underwent right-sided transthoracic esophagectomy and extended thoracic/abdominal two-field lymphadenectomy. Patients with pathologically confirmed lymph node metastasis or tumor recurrence constituted the high-risk group for endoscopic submucosal resection, and the remainder were defined as low risk. Factors affecting lymphatic metastasis and long-term recurrence were identified by univariate and multivariate analyses.

Results: Postoperative pathology showed that five patients (5/167; 3%) had lymph node metastases. Follow-up ranged from 12-60 months, with a median of 29 months. A total of 17 patients (10.2%) had recurrences during follow-up, including three patients with pathologic nodal metastasis (pN +) found at surgery. Invasion depth, differentiation, and tumor size differed significantly in high-risk patients. Overall 3-year survival rates were 94.2% (low-risk) and 40.9% (high-risk) (p < 0.01). Twenty-one patients with sm1 cancer, high tumor differentiation, and tumor length < 2 cm had no lymph node metastasis or lymphovascular invasion, and none of these patients experienced recurrence.

Conclusions: Endoscopic submucosal resection alone may be feasible for patients with small (≤ 2 cm) clinically N0 submucosal esophageal squamous cell carcinoma with low invasion depth (sm1) and higher differentiation, but prospective studies are required for confirmation. Other patients require surgical resection with extended two-field thoracic/abdominal lymphadenectomy.

Keywords: Clinical N0 pathologic T1b; Endoscopic submucosal resection; Esophageal; Squamous cell carcinoma.

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Conflict of interest statement

Dr. Bo Ye, Dr. Xiaobin Zhang, Dr. Yuchen Su, Dr. Shuguang Hao, Dr. Haohua Teng, Dr. Xufeng Guo, Dr. Yu Yang, Dr. Yifeng Sun, Dr. Teng Mao, and Dr. Zhigang Li have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flow chart showing the patient selection process for the study
Fig. 2
Fig. 2
Overall survival in low- and high-risk patients with clinical N0 pathological T1b esophageal squamous cell carcinoma after endoscopic submucosal resection. OS overall survival
See this image and copyright information in PMC

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