Satisfactory long-term progress in patients treated by endoscopic mucosal resection for high-grade dysplasia or superficial squamous cell cancer of the esophagus

Introduction: Endoscopic mucosal resection (EMR) is a curative treatment of early squamous cell carcinoma (SCC) of the esophagus. The objective was to evaluate the efficacy, safety, long-term outcome, and survival of EMR. Patients and methods: Forty-four patients were treated by EMR between February 1998 and October 2005 for an early SCC of the esophagus. The technique of EMR was carried out by suction and section with cap or traction and section, or by the combination of both. Results: Forty-four patients had endoscopic treatment with resection of 49 early SCC. They were all of T1N0 stage as found by standard endoscopic ultrasound (EUS). No major complications occurred. The median endoscopic follow-up was 44 months. A curative resection (T1m1, T1m2) was achieved in 68% of cases without recurrence. Among patients with T2 lesion (16%), 6 had a radio-chemotherapy and only 1 patient died because of the metastatic evolution of esophageal cancer. The remaining 2 left patients had a complementary esophagectomy, among whom 1 died after recurrence. Eight patients had a histologically significant risk of nodes invasion (2 m3, 3 sm1, 2 sm2, and 1 sm3), and 6 had a complementary radio-chemotherapy without recurrence in the follow-up. Conclusion: SCC of the esophagus shown usT1N0 in EUS can be treated curatively by endoscopic mucosal resection with a high rate of resecability (98%) and an acceptable complication rate. In the subgroup of 12 patients (m3 sm1, sm2, sm3 and T2) that were treated by complementary radiochemotherapy, the 5-year overall survival was 91%. To cite this journal: Acta Endosc. 41 (2011).