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Long-term outcomes of endoscopic versus surgical resection for MM-SM1 esophageal squamous cell carcinoma using propensity score analysis

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Abstract

Background

Esophageal squamous cell carcinoma (ESCC) confined to the muscularis mucosae (MM) or up to 200 µm of the submucosa (SM1) confers the risk for lymph node metastasis, and is defined as relative indication for endoscopic submucosal dissection (ESD) by the Japan Esophageal Society guidelines. Although additional surgical treatment after ESD is recommended, long-term outcomes of ESD compared with those of surgery have not been clarified. This study aimed to evaluate the long-term outcomes of ESD and surgery for cN0M0 relative indication lesions of ESCC.

Methods

Between 2006 and 2016, patients with relative indication lesions of ESCC who underwent ESD or surgery at nine participating hospitals were examined retrospectively. Using propensity score matching, we evaluated survival curves for and hazard ratios associated with endoscopic submucosal dissection and surgery.

Results

In total, 155 lesions in the ESD group and 106 lesions in the surgery group met the pathological criteria of relative indication for endoscopic resection. After matching, 50 matched pairs of patients who underwent ESD or surgery were selected. The 5-year overall survival rates were 84.5% [95% confidence interval (CI) 68–93] in the ESD group and 79% [95% CI 60–90] in the surgery group. The hazard ratio of mortality for ESD compared with that for surgery estimated by Cox regression analysis was 0.79 (95% CI 0.3–2.06, p = 0.63).

Conclusions

Compared with surgery, ESD does not compromise long-term outcomes. ESD alone or ESD with chemotherapy and/or radiotherapy may be an option for the treatment of MM and SM1 ESCC.

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Funding

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Authors and Affiliations

  1. Department of Gastroenterology, Mitoyo General Hospital, 708, Himehama, Toyohama-cho, Kannonji, Kagawa, 769-1695, Japan

    Kenji Yamauchi

  2. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan

    Masaya Iwamuro, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara & Hiroyuki Okada

  3. Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

  4. Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, 708-0841, Japan

    Ryuta Takenaka

  5. Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, 710-8602, Japan

    Kazuhiro Matsueda

  6. Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, 760-8557, Japan

    Tomoki Inaba

  7. Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8511, Japan

    Masao Yoshioka

  8. Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, 720-8520, Japan

    Tatsuya Toyokawa

  9. Department of Gastroenterology, Iwakuni Clinical Center, Iwakuni, Yamaguchi, 740-8510, Japan

    Shouichi Tanaka

  10. Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan

    Yasuhiro Shirakawa

Authors
  1. Kenji Yamauchi
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  2. Masaya Iwamuro
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  3. Masahiro Nakagawa
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  4. Ryuta Takenaka
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  10. Hiromitsu Kanzaki
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  11. Seiji Kawano
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  13. Yasuhiro Shirakawa
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  14. Hiroyuki Okada
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Consortia

Okayama Gut Study Group

Contributions

KY, MN, RT, KM, TI, MY, TT, and ST collected the data; KY designed and analyzed the data; KY and MI drafted the manuscript; HK, SK, YK, YS, and HO revised the manuscript for important intellectual content. All authors have read and approved the final version to be published.

Corresponding author

Correspondence to Kenji Yamauchi.

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Ethical statement

As the patients were registered and analyzed retrospectively in this observational study, the need for written informed consent was waived. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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The authors declare that there are no conflicts of interest associated with this article.

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Yamauchi, K., Iwamuro, M., Nakagawa, M. et al. Long-term outcomes of endoscopic versus surgical resection for MM-SM1 esophageal squamous cell carcinoma using propensity score analysis. Esophagus 18, 72–80 (2021). https://doi.org/10.1007/s10388-020-00775-0

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  • DOI: https://doi.org/10.1007/s10388-020-00775-0

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