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Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy

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Abstract

Background

The surgery for esophageal cancer arising after prior gastrectomy is technically difficult with high morbidity and mortality. Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment for superficial SCC with high curative resection rate. But few studies are concerned about ESD under these circumstances. The aim of this study was to elucidate the short- and long-term outcomes of ESD for superficial esophageal squamous cell cancer (SCC) in patients with prior gastrectomy.

Methods

From January 2009 to January 2019, 37 patients with prior gastrectomy who underwent ESD for superficial esophageal SCC were retrospectively enrolled at the Zhongshan Hospital, Fudan University in Shanghai, China. Rates of en bloc resection, complete resection, curative resection, incidence of postoperative bleeding, perforation and postoperative stricture were evaluated as short-term outcomes. Overall survival, and local recurrence-free survival were evaluated as long-term outcomes.

Results

The rate of en bloc resection, complete resection and curative resection were 94.6%, 86.5% and 78.4%, respectively. No perforation was observed. 1 (2.7%) patient experienced postoperative bleeding. During the median observation of 43 months, 3 (8.6%) patients experienced esophageal stricture, successfully managed by balloon dilation. 3(8.6%) patients had local recurrence after ESD with 5-year local recurrence-free survival rate of 91.4%. During the observation period, 4 patients died of other reasons. The 1, 3, 5-year overall survival rates were 97.1%, 97.1% and 91.4%.

Conclusions

The short-term outcomes indicate ESD is technically difficult with lower resection completeness in patients after gastrectomy, while the long-term outcomes are rather favorable.

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Abbreviations

ESD:

Endoscopic submucosal dissection

SCC:

Squamous cell cancer

CRT:

Chemoradiation therapy

SM:

Submucosae

MM:

Muscularis mucosa

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Funding

This study was supported by grants from the National Natural Science Foundation of China (81873552, 81570595, and 81670483), Shanghai Rising-Star Program (19QA1401900), Major Project of Shanghai Municipal Science and Technology Committee (18ZR1406700, 16411950400, 16DZ2280900), Outstanding Young Doctor Training Project of Shanghai Municipal Commission of Health and Family Planning (2017YQ026), and Chen Guang Program of Shanghai Municipal Education Commission (15CG04). For the remaining authors none were declared.

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Author notes

  1. Jia-Qi Xu, Jian-Wei Hu, and Wei-Feng Chen have shared co-first authorship.

Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People’s Republic of China

    Jia-Qi Xu, Jian-Wei Hu, Wei-Feng Chen, Mei-Dong Xu, Yun-Shi Zhong, Shi-Yao Chen, Yi-Qun Zhang, Li-Li Ma, Wen-Zheng Qin, Ming-Yan Cai, Li-Qing Yao, Ping-Hong Zhou & Quan-Lin Li

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  1. Jia-Qi Xu
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Contributions

All the authors meet all of the following 3 conditions: (1) they make substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; (2) they participate in drafting the article or revising it critically for important intellectual content; and (3) they give final approval of the version to be published. In particular, JQX, JWH, and WFC mostly collect, analyze and interpret data. They also draft the article. So they share the first co-authorship. MDX, YSZ, SYC, YQZ, LLM, WZQ, MYC and LQY mostly contribute cases and revise the article. PHZ and QLL came up with the conception, designed the study and supervise the research group.

Corresponding authors

Correspondence to Ping-Hong Zhou or Quan-Lin Li.

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Disclosures

Jiaqi Xu, Jianwei Hu, Weifeng Chen, Meidong Xu, Yunshi Zhong, Shiyao Chen, Yiqun Zhang, Lili Ma, Wenzheng Qin, Mingyan Cai, Liqing Yao, Pinghong Zhou and Quanlin Li have no conflict of interest or financial ties to disclose.

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Xu, JQ., Hu, JW., Chen, WF. et al. Short- and long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell cancer in patients with prior gastrectomy. Surg Endosc 35, 2229–2239 (2021). https://doi.org/10.1007/s00464-020-07636-y

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