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Hassan C, Antonelli G, Chiu PWY, Emura F, Goda K, G Iyer P, Al Awadhi S, Al Lehibi A, Arantes V, Burgos H, Cerisoli CL, Dawsey S, Draganov P, Fleischer D, Fluxá F, Gonzalez N, Inoue H, John S, Kashin S, Khashab M, Kim GH, Kothari S, Yeh Lee Y, Ngamruengphong S, Remes-Troche JM, Sharara AI, Shimamura Y, Varocha M, Villa-Gomez G, Wang KK, Wang WL, Yip HC, Sharma P. Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasiaia. Dig Endosc 2025; 37:470-489. [PMID: 39722219 DOI: 10.1111/den.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 11/10/2024] [Indexed: 12/28/2024]
Abstract
Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1-1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high-grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high-risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high-level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.
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Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Rome, Italy
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Philip Wai-Yan Chiu
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Fabian Emura
- Digestive Health and Liver Diseases, University of Miami, Miami, USA
- Interventional Endoscopy Center, Jackson Memorial Hospital, Miami, USA
| | - Kenichi Goda
- Gastrointestinal Endoscopy Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Prasad G Iyer
- Esophageal Interest Group, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | - Sameer Al Awadhi
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Abed Al Lehibi
- Gastroenterology and Hepatology Department, King Fahad Medical City, Riyad, Saudi Arabia
| | - Vitor Arantes
- Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Brazil
| | - Herbert Burgos
- World Gastroenterology Organization-Training Center in Costa Rica, University of Costa Rica, FASGE, Costa Rica, Central America
| | - Cecilio L Cerisoli
- Therapeutic and Diagnostic Gastroenterology (GEDYT) Center, Buenos Aires, Argentina
| | - Sanford Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Maryland, USA
| | | | - David Fleischer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, USA
| | - Fernando Fluxá
- Gastroenterology Department Clinica Meds, Santiago, Chile
| | | | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Sneha John
- Endoscopy Unit, Gold Coast University Hospital, Southport, Australia
| | - Sergey Kashin
- Endoscopy Department, Yaroslavl State Medical University, Yaroslavl, Russia
| | - Mouen Khashab
- Therapeutic Endoscopy, Johns Hopkins Hospital, Baltimore, USA
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Shivangi Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, USA
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | | | | | - Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Mahachai Varocha
- Center of Excellence in Digestive Diseases, Thammasat University, Bangkok, Thailand
| | - Guido Villa-Gomez
- Gastroenterology and Digestive Endoscopy Unit, WGO La Paz Training Center, La Paz, Bolivia
| | - Kenneth K Wang
- Russ and Kathy Van Cleve Professor of Gastroenterology, Mayo Clinic, Rochester, USA
| | - Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Hon-Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Prateek Sharma
- University of Kansas School of Medicine and VA Medical Center, Kansas City, USA
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Tang Z, Feng S, Liu Q, Ban Y, Zhang Y. Using Pathomics-Based Model for Predicting Positive Surgical Margins in Patients with Esophageal Squamous Cell Carcinoma: A Comparative Study of Decision Tree and Nomogram. Int J Gen Med 2024; 17:5869-5882. [PMID: 39659511 PMCID: PMC11629666 DOI: 10.2147/ijgm.s495296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 11/20/2024] [Indexed: 12/12/2024] Open
Abstract
Objective Esophageal squamous cell carcinoma (ESCC) has a high incidence and mortality rate. Postoperative positive surgical margins (PSM) often correlate with poor prognosis. This study aims to develop and validate a predictive model for PSM positivity in ESCC patients, with the potential to guide preoperative planning and improve patient outcomes. Methods We conducted a retrospective analysis of 1776 patients who underwent esophageal cancer surgery at the First Affiliated Hospital of Jilin University between January 2015 and December 2023. Patients with visible residual tumors (R2) or microscopic residual tumors (R1) at the surgical margins were classified as having PSM. High-dimensional pathological features were extracted from digital pathological sections using CellProfiler software. The selected features were used to develop a predictive model based on decision trees and generalized linear regression, and the model was validated in an independent cohort. Clinically significant pathological factors (P < 0.05) were included in multivariate logistic regression for further validation. The model's performance was assessed using calibration curves and receiver operating characteristic (ROC) curves, generated with the Bootstrap method. Decision curve analysis (DCA) was employed to evaluate the clinical utility of the predictive model. Results A total of 229 patients (12.89%) were diagnosed with PSM. Logistic regression analysis identified multifocal lesions, vascular invasion, and pathomics-based features as independent predictors of PSM. The predictive model, represented by a decision tree, demonstrated good discrimination with an area under the ROC curve of 0.899 (95% CI: 0.842-0.956, P < 0.001), and a strong calibration curve between the predicted probability and the actual probability. Additionally, the nomogram demonstrated slightly inferior discrimination with an area under the ROC curve of 0.803 (95% CI: 0.734-0.872, P < 0.001) in the training cohort. Conclusion Our study successfully established and validated a pathology-based predictive model for PSM risk, which could enhance preoperative evaluation and inform treatment strategies for ESCC.
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Affiliation(s)
- Ze Tang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Shiyun Feng
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Qing Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Yunze Ban
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Yan Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
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Furue Y, Yoda Y, Hori K, Nakajo K, Kadota T, Murano T, Shinmura K, Ikematsu H, Yano T. Outcomes of repeated endoscopic submucosal dissection for superficial Esophageal squamous cell carcinoma on endoscopic resection scar. Dis Esophagus 2024; 37:doae018. [PMID: 38553782 DOI: 10.1093/dote/doae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 02/29/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) can be performed for superficial esophageal cancer. However, performing ESD for superficial esophageal cancer on a previous endoscopic resection scar may be difficult. METHODS We compared the outcomes between ESD for superficial esophageal cancers on previous endoscopic resection scar (group A) and that for naïve lesions (group B). The study included outcomes of ESD, cumulative incidence of local failure, and predictors of the occurrence of local failure in ESD patients with squamous cell carcinoma (SCC). The outcome variables evaluated were en bloc resection rates, procedure times, adverse events, and overall survival rates. RESULTS Overall, 220 lesions were extracted (groups A and B: 23 and 197 lesions, respectively). In groups A and B, the complete resection rates were 60.9 and 92.9% (P < 0.001), and the mean procedure times were 79 and 68 min (P = 0.15), respectively. The perforation rates in groups A and B were 4.3 and 1% (P = 0.28). The 1-year cumulative local failure rates were 22 and 1% (P < 0.001), respectively. In the multivariate Cox proportional hazards analysis, superficial esophageal SCC on a previous endoscopic resection scar was a strong predictor of local failure (hazard ratio = 21.95 [3.99-120.80], P < 0.001). The 3-year overall survival rates in groups A and B were 95 and 93% (P = 0.99), respectively. CONCLUSIONS Repeated ESD on scar is an option for treating superficial esophageal SCC with an acceptable rate of adverse events. Because of the low complete resection rate and high local failure compared with conventional ESD, strict endoscopic follow-up is required after repeated esophageal ESD.
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Affiliation(s)
- Yasuaki Furue
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Department of Endoscopy, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Keisuke Hori
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Department of gastroenterology, Ichinomiyanishi Hospital, Ichinomiya, Aichi, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Abula G, Song WX, Liu H, Ren XF, Chen X. Prediction model for selection of adjuvant therapy population after endoscopic submucosal dissection for early esophageal lesions. Shijie Huaren Xiaohua Zazhi 2022; 30:587-598. [DOI: 10.11569/wcjd.v30.i13.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic treatment is the first choice for early esophageal lesions without obvious metastasis or infiltration, especially endoscopic submucosal dissection (ESD). However, the occurrence of non-curative resection, recurrence, or metastasis after ESD is inevitable, which may require adjuvant therapy such as additional surgery or chemora-diotherapy.
AIM To analyze the risk factors for additional surgery or chemora-diotherapy after ESD for early esophageal lesions, and explore the effect of curative resection on additional adjuvant therapy.
METHODS Patients who underwent ESD for stage T1 esophageal cancer (EC) and precancerous lesions were analyzed retrospectively. Postoperative recurrence, metastasis, and adjuvant treatment were followed, and a prediction model for adjuvant treatment population selection was established.
RESULTS Non-curative resection was correlated with patient age, proportion of lesions, and microscopic size(P < 0.05), among which the proportion of lesions > 2/3 (odds ratio [OR] = 7.958, P = 0.007) was an independent risk factor. Two of curative and ten of non-curative resection cases received additional treatment, indicating that further treatment after ESD might be required regardless of whether curative resection was performed. Patient age, proportion of lesions, lesion lifting, differentiation, vascular invasion, and tumor invasion depth were correlated with the need for further treatment (P < 0.05). Age ≥ 70 years (OR = 4.210, P = 0.049), poor lifting (OR = 18.171, P = 0.047), and depth of tumor up to SM2 (OR = 38.781, P = 0.012) were independent risk factors. The AUC of the nomogram model was 0.864 (95%CI: 0.766-0.962); the specificity and sensitivity were 95.8% and 75.0%, respectively. Calibration curve analysis, decision curve analysis, and Hosmer and Lemeshow test (χ2 = 1.5954, P = 0.991) showed that the predictive value of the model was acceptable.
CONCLUSION For patients with stage T1 EC and precancerous lesions, whether further surgery or chemoradiotherapy is needed after ESD should be comprehensively considered.
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Affiliation(s)
- Gulisitan Abula
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen-Xuan Song
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hang Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiang-Feng Ren
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Sun D, Shi Q, Qi Z, Li B, Cai S, Zhou P, Zhong Y. Simultaneous endoscopic submucosal dissection for synchronous multiple early esophageal squamous cell carcinoma: a propensity score-matched analysis. Surg Endosc 2022; 36:109-116. [PMID: 33416991 DOI: 10.1007/s00464-020-08243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The clinical effect of endoscopic submucosal dissection (ESD) in the treatment of early esophageal squamous cell carcinoma (EESCC) is widely recognized. However, the long-term treatment outcome of simultaneous ESD for multiple EESCC currently remained unknown. Hence, this study was aimed at further evaluating the long-term outcome of simultaneous ESD for synchronous multiple EESCC by comparing with ESD for single EESCC. METHODS Consecutive patients who underwent ESD for EESCC from June 2008 to June 2018 were included. Propensity score-matched analysis was used to compensate for the differences in age, sex, tumor location, tumor size, and tumor invasion depth between simultaneous and single ESD groups. Treatment outcomes including en bloc resection rate, curative resection rate, complication rate, and long-term outcomes including overall survival (OS), recurrence-free survival (RFS), metachronous recurrence were compared between the 2 groups after matching. RESULTS The propensity score-matched analysis included 332 lesions (166 patients) and 332 lesions (332 patients) in simultaneous and single ESD groups, respectively. Among all the outcomes, en bloc resection, curative resection, 5-year OS, and 5-year RFS rates were comparable. Complications were more common in the simultaneous ESD group (15.06% vs. 9.64%, P = 0.073). The 5-year metachronous recurrence rates were significantly high in the simultaneous ESD groups (24.28% vs. 6.99%). CONCLUSIONS Simultaneous ESD is an effective and safe methodology for synchronous multiple EESCC; it also reduces hospital stay and medical expenses. The risk of metachronous recurrence is higher for patients with synchronous multiple EESCC; thus, more intensive strategies are required.
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Affiliation(s)
- Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - ZhiPeng Qi
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Shilun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China
| | - Pinghong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
| | - Yunshi Zhong
- Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
- Endoscopy Research Institute of Fudan University, Shanghai, 200032, China.
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Repeated Endoscopic Submucosal Dissection for Esophageal Neoplasia Located Close to a Previous Endoscopic Submucosal Dissection Scar. Clin Transl Gastroenterol 2021; 11:e00226. [PMID: 32955199 PMCID: PMC7423925 DOI: 10.14309/ctg.0000000000000226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION: Endoscopic submucosal dissection (ESD) could become a standard treatment for early stage esophageal neoplasia. Recurrence sometimes develops close to a previous ESD scar. These lesions are predictably difficult to treat with ESD because of severe fibrosis. We evaluated the clinical outcomes of ESD for esophageal neoplasia located close to a previous ESD scar. METHODS: This was a retrospective observational study in a single institution. A total of 549 consecutive patients with 927 esophageal lesions were treated with ESD. The primary outcomes were resectability and adverse events of esophageal neoplasia located close to previous ESD scars (ESD scar group) than in primary esophageal ESD (primary group). Furthermore, predictive factors of perforation were examined. RESULTS: A total of 545 primary and 29 ESD scars in consecutive patients were evaluated. En bloc and complete (R0) resection rates in the ESD scar group were lower than those in the primary group (79.3% vs 98.3%, P < 0.01 and 75.9% vs 93.4%, P < 0.01). Perforations occurred more frequently in the ESD scar group (10.3% vs 2.0%, P = 0.03). The ESD scar group was a predictive factor for perforation (odds ratio = 10.37, 95% confidence interval: 2.15–49.94, P = 0.004). There were similar results for inverse probability of treatment weighting methods (odds ratio = 6.78, 95% confidence interval: 1.40–32.98, P = 0.018). DISCUSSION: ESD for esophageal neoplasia located close to a previous ESD scar was difficult to completely resect and increased the likelihood of perforation but could be a treatment option.
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Fukuda H, Ishihara R, Shimamoto Y, Kono M, Nakagawa K, Ohmori M, Matsuno K, Iwagami H, Inoue S, Iwatsubo T, Nakahira H, Matsuura N, Shichijo S, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Uedo N, Kitamura M, Nakatsuka S. Effect of horizontal margin status and risk of local recurrence after endoscopic submucosal dissection for superficial esophageal cancer. JGH Open 2020; 4:160-165. [PMID: 32280759 PMCID: PMC7144764 DOI: 10.1002/jgh3.12233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) sometimes results in en bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. The specific risk for such situations is unclear. We therefore investigated the outcome of ESD with HM1 or HMX. METHODS This single-center retrospective study was performed at Osaka International Cancer Institute. A total of 886 esophageal squamous cell carcinoma lesions in 749 patients treated from April 2005 to June 2015 were evaluated according to the following inclusion criteria: en bloc resection with no residual lesion, HM1 or HMX status, no prior treatment, and no additional treatment. We classified HM1 and HMX into type A, in which cancer was exposed on the HM, and type B, in which the HM status was unclear because of mechanical or thermal damage. We further classified type B according to the distance between the cancer and the edge of the specimen: type B1, <1 mm and type B2, ≥1 mm. RESULTS The resection margin was judged as HM1 or HMX in 5.0% (39/767; 95% confidence interval, 3.5-6.6%) of the en bloc resected specimens. Of 39 lesions, 30 fulfilled the inclusion criteria. Local recurrence developed in 8 of 30 lesions (26.7%). The local recurrence rates for types A, B1, and B2 were 40% (6/15 lesions), 28.5% (2/7 lesions), and 0.0% (0/8 lesions), respectively. CONCLUSIONS Although a statistical analysis was not conducted because of the limited events, the pathological HM status may be a useful predictor of local recurrence.
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Affiliation(s)
- Hiromu Fukuda
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ryu Ishihara
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yusaku Shimamoto
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Mitsuhiro Kono
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kentaro Nakagawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masayasu Ohmori
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenshi Matsuno
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Shuntaro Inoue
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Taro Iwatsubo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroko Nakahira
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriko Matsuura
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Satoki Shichijo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Akira Maekawa
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takashi Kanesaka
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Koji Higashino
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Noriya Uedo
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masanori Kitamura
- Department of PathologyOsaka International Cancer InstituteOsakaJapan
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Macroscopic Assessment and Sampling of Endoscopic Resection Specimens for Squamous Epithelial Malignancies with Superficial Involvement of Esophagus. Methods Mol Biol 2020; 2129:63-81. [PMID: 32056170 DOI: 10.1007/978-1-0716-0377-2_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic resection is commonly used for superficial squamous cell carcinoma or high-grade dysplasia of esophageal squamous cell carcinoma. The depth of invasion, clearance from resection margins, and other pathological parameters are important parameters to be examined. The depth of invasion by carcinoma is associated with the risk of lymph node metastases. In endoscopic resection of superficial squamous malignancies of the esophagus, proper pathological examination of the resected specimen could guide the management of the patients in terms of the need for additional treatment, including lymph node dissection, chemotherapy, and radiation therapies.
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Kinoshita S, Nishizawa T, Ochiai Y, Fujimoto A, Takabayashi K, Kato M, Goto O, Maehata T, Yahagi N, Uraoka T. Salvage endoscopic submucosal dissection for incompletely resected esophageal or gastric neoplasms (case series). Endosc Int Open 2020; 8:E20-E24. [PMID: 31921980 PMCID: PMC6949167 DOI: 10.1055/a-0998-3917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/11/2019] [Indexed: 01/25/2023] Open
Abstract
Background and study aims Given that positive lateral margins indicate possible residual carcinoma, salvage endoscopic submucosal dissection (ESD) should be considered for curative therapy. Presence of submucosal fibrosis, however, makes the procedure difficult to perform. We present our case series to discuss the feasibility of salvage ESD and the timing of the procedure.
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Affiliation(s)
- Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Toshihiro Nishizawa
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine,Department of Gastroenterology and Hepatology, International University of Health and Welfare Mita Hospital
| | - Yasutoshi Ochiai
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Ai Fujimoto
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Osamu Goto
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center,Department of Gastroenterology, Nippon Medical School
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
| | - Toshio Uraoka
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Gunma University, Gunma, Japan,Corresponding author Toshio Uraoka, MD, PhD Department of Gastroenterology and HepatologyGunma University Graduate School of Medicine3-39-15 Showamachi, Maebashi-shiGunma 371-8511Japan+81-3-3412-9811
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Wang J, Zhu XN, Zhu LL, Chen W, Ma YH, Gan T, Yang JL. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions. World J Gastroenterol 2018; 24:2878-2885. [PMID: 30018482 PMCID: PMC6048426 DOI: 10.3748/wjg.v24.i26.2878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/02/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection (ESTD) for esophageal squamous cell carcinoma (ESCC) and precancerous lesions.
METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.
RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period.
CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.
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Affiliation(s)
- Jin Wang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
- State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Nan Zhu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Lin Zhu
- Department of General Practice, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei Chen
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Han Ma
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Gan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Wang WP, Ni PZ, Yang JL, Wu JC, Yang YS, Chen LQ. Esophagectomy after endoscopic submucosal dissection for esophageal carcinoma. J Thorac Dis 2018; 10:3253-3261. [PMID: 30069321 DOI: 10.21037/jtd.2018.05.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Endoscopic submucosal dissection (ESD) has been used to treat early stage esophageal cancer, but reports about additional esophagectomy after ESD and postoperative outcomes are lacking. Complete removal of cancer tissue together with lymph nodes was the advantage of esophagectomy; however, invasiveness, organ loss, postoperative complications, and worse postoperative quality of life were serious disadvantages. The purpose of this study was to find the clear indication of additional esophagectomy after ESD, and help the other patients avoid excessive surgery. Methods We reviewed the clinicopathologic data and outcomes consecutive patients who had esophageal cancer confirmed by endoscopic biopsy and who were treated with ESD and subsequent esophagectomy between October 2011 and December 2016 in our department. The esophagectomy necessity following ESD was defined and the groups with necessity (+) vs. (-) were compared retrospectively. The esophagectomy necessity outcomes were retrospectively analyzed to judge whether the surgery option was correct. Results Total 214 patients with esophageal and esophagogastric cancer have undergone ESD treatment in our center, of which 32 patients (23 men and 9 women; mean age, 60±8 years) ultimately required esophagectomy after ESD. All patients had complete resection (R0) from esophagectomy. Postoperative TNM staging included TisN0M0 (6 patients), T1aN0M0 (6 patients), T1bN0M0 (18 patients), T1bN1M0 (1 patient), and T2N3M0 (1 patient). Necessity of esophagectomy after ESD was associated with residual margin status. There was a significant difference in ESD specimen margin status between the esophagectomy necessity (+) vs. (-) groups (positive/negative margin: 8/3 vs. 2/9 patients; P=0.03). Esophagectomy should be delayed at least 30 days after ESD to enable resolution of esophageal edema (P=0.017) (206±68 vs. 163±56 mL, P=0.057). Median follow-up was 16.8 months (range, 11.2-54.5 months); 3 patients were lost to follow-up (9%) and 1 patient died of metastasis after esophagectomy. All other patients were alive with excellent postoperative disease-free survival. Conclusions Indications for esophagectomy after ESD include ESD failure, cancer recurrence, esophageal rupture, esophageal stricture refractory to endoscopic dilation, and residual tumor at the ESD specimen margin. Stage T1b alone is not an indication for esophagectomy. According to our study, we recommend that esophagectomy should be delayed ≥30 dafter ESD unless urgent esophagectomy is indicated.
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Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Peng-Zhi Ni
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun-Chao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Peng C, Shen S, Xu G, Lv Y, Zhang X, Ling T, Wang L, Ding X, Zou X. Efficacy and safety of endoscopic submucosal dissection for elderly patients with superficial squamous esophageal neoplasms. United European Gastroenterol J 2015; 4:242-9. [PMID: 27087953 DOI: 10.1177/2050640615604780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 08/15/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the outcomes of endoscopic submucosal dissection in elderly patients with superficial squamous esophageal neoplasms. OBJECTIVE To assess the efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasms in elderly patients (≥65 years) compared with non-elderly patients. METHODS All patients with superficial squamous esophageal neoplasms receiving endoscopic submucosal dissection were retrospectively analyzed. Among them, 130 were aged 65 or older (group A), and 201 were aged younger than 65 years (group B). Therapeutic efficacy, adverse events, and follow-up data were evaluated. RESULTS Group A had a higher prevalence of concomitant diseases than group B (52.3% vs. 14.9%, respectively). R0 resection rate was 82.3% in group A and 84.6 % in group B (P = 0.717). The curative resection rate was 80.8% in group A and 83.6% in group B (P = 0.653). The rate of procedure-related non-cardiopulmonary adverse events was 20.8% in group A and 16.9% in group B (P = 0.377). The incidence of cardiopulmonary adverse events during or after the procedure was 6.2% in group A and 2.5% in group B (P = 0.094). No procedure-related mortality was reported in either group. CONCLUSION Endoscopic submucosal dissection is effective and safe for treating superficial squamous esophageal neoplasms in elderly patients.
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Affiliation(s)
- Chunyan Peng
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China; Drum Tower Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Shanshan Shen
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Guifang Xu
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Ying Lv
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Xiaoqi Zhang
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Tingsheng Ling
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Lei Wang
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Xiwei Ding
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
| | - Xiaoping Zou
- Department of Gastroenterology, the Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, P.R. China
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Mei XC, Sun B, Xu JM, Kong DR. Clinical effects of endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric and esophageal cancer and precancerous lesions. Shijie Huaren Xiaohua Zazhi 2014; 22:4954-4959. [DOI: 10.11569/wcjd.v22.i32.4954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the feasibility, safety and efficacy of endoscopic mucosal resection (EMR) vs endoscopic submucosal dissection (ESD) for early gastric and esophageal cancer and precancerous lesions.
METHODS: A retrospective analysis was performed of 93 patients with early gastric/esophageal cancer or precancerous lesions who were endoscopically and pathologically diagnosed and managed by ESD or EMR at our hospital from March 2011 to June 2014. The patients were divided into either an ESD group (61 patients) or an EMR group (32 patients). The operative time, size of the lesion, en bloc resection rate, surgical complications and postoperative recurrence were compared for the two groups to evaluate their feasibility, safety and efficacy.
RESULTS: There was no significant difference in age or lesion size between the two groups. The en bloc rate was significantly higher in the ESD group than in the EMR resection (91.8% vs 56.3%, P < 0.05). There are five cases of bleeding in the ESD group and one in the EMR group, and no delayed bleeding occurred in either group. There was only one case of perforation, which occurred in the ESD group. During the 3-42-month postoperative follow-up, there was no recurrence in the ESD group, but four cases of recurrence occurred in the EMR group.
CONCLUSION: Compared with EMR for early gastric and esophageal cancer and precancerous lesions, ESD shows considerable advantages regarding en bloc resection rate and local recurrence, although there is no significant difference in bleeding or perforation.
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