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Additional Esophagectomy Following Noncurative Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma: A Multicenter Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Esophagectomy is recommended after endoscopic resection (ER) for early esophageal squamous cell carcinoma (ESCC) when histopathological factors indicate a risk of nodal metastasis and incomplete resection. We aimed to analyze the outcomes of surgery management in this clinical setting and evaluate risk factors for residual disease after ER.

Patients and Methods

We conducted a retrospective review of cT1N0M0 ESCC patients with noncurative ER and additional esophagectomy (2009–2019, eight centers). Noncurative ER was defined as positive resected margins on pathology, lymphovascular invasion (LVI), poor differentiation, or submucosal invasion. The pathology after ER and esophagectomy was analyzed to identify predictors of nodal metastasis and residual tumor.

Results

The study enrolled 128 patients. Primary residual tumor and nodal metastasis were confirmed in 25 (19.5%) and 15 (11.7%) patients, respectively. On multivariate analysis, nodal metastasis was independently associated with submucosal invasion [odds ratio (OR), 9.9; 95% CI, 1.1–96.1], LVI (OR, 20.9; 95% CI, 2.9–150.5), and tumor size ≥ 2 cm (OR, 8.1; 95% CI, 1.4–48.2) (all P < 0.05), but not with poor differentiation (P = 0.613). Regarding residual primary tumor, only positive vertical margin was significant factor (OR, 147; 95% CI, 18 to > 999; P < 0.001).

Conclusions

Additional esophagectomy after noncurative ER allowed the resection of residual tumor and nodal metastasis, with favorable outcomes. Close follow-up may be feasible for a positive horizontal margin alone or poor differentiation alone, whereas intensive treatment should be considered for patients with submucosal invasion, LVI, and a positive vertical margin, especially when combined with tumor size ≥ 2 cm. Prospective research is needed to confirm the optimal management after ER.

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Acknowledgment

This study was funded by Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No. 20181816). The authors sincerely thank the Yangtze River & Shanghai Chest Esophageal Cooperative Group for assistance with the data collection.

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Author notes

  1. Zhichao Liu, Jie Zhang and Yuchen Su have contributed equally to this paper.

Authors and Affiliations

  1. Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Zhichao Liu MD, Jie Pan MD, Yang Yang PhD & Zhigang Li PhD

  2. Center for Esophageal Diseases, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

    Zhichao Liu MD, Jie Zhang PhD & Yuchen Su MD

  3. Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Jie Zhang PhD & Binhao Huang MD

  4. Department of Cardiothoracic Surgery, Huai’an First People’s Hospital, Nanjing Medical University, Jiangsu, China

    Jianqiang Zhao PhD

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  1. Zhichao Liu MD
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Correspondence to Zhigang Li PhD.

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Ethical Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). As all the data were anonymous, it was deemed exempt from the requirement to gather participant consent by the institutional review board of all participating hospitals.

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Liu, Z., Zhang, J., Su, Y. et al. Additional Esophagectomy Following Noncurative Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma: A Multicenter Retrospective Study. Ann Surg Oncol 28, 7149–7159 (2021). https://doi.org/10.1245/s10434-021-10467-3

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