Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy

• Published in: Gastrointestinal endoscopy Vol. 67; no. 2; pp. 355 - 359
• Main Authors: Saito, Yutaka, MD, PhD, Takisawa, Hajime, MD, Suzuki, Haruhisa, MD, Takizawa, Kouhei, MD, Yokoi, Chizu, MD, Nonaka, Satoru, MD, Matsuda, Takahisa, MD, Nakanishi, Yukihiro, MD PhD, Kato, Ken, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2008; Elsevier
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Combined Modality Therapy; Digestive system. Abdomen; Dissection - methods; Endoscopy; Endoscopy, Gastrointestinal; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Esophagus; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Mucous Membrane; Neoplasm Recurrence, Local - surgery; Neoplasm, Residual - surgery; Recurrence; Tumors; insulation-tipped–knife; IT-knife; CRT; B-knife; submucosal; chemoradiotherapy; endoscopic submucosal dissection; squamous-cell carcinoma; bipolar needle-knife; National Cancer Center Hospital; SCC; ESD; sm; NCCH; Human; Relapse; Esophageal disease; Digestive diseases; Submucosal resection; Malignant tumor; Endoscopy; Chemoradiotherapy; Esophagus cancer; Cancer
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.10.008

Background Treatment of local recurrent or residual superficial esophageal squamous-cell carcinoma (SCC) with conventional EMR often results in a piecemeal resection that requires further intervention. Objective The aim of this study was to evaluate the efficacy of endoscopic submucosal dissection (ESD). Design A case series. Patients Between January 2006 and September 2006, 4 local recurrent or residual superficial esophageal SCCs were treated by ESD. Interventions ESD procedures were performed by using a bipolar needle knife and an insulation-tipped knife. After injection of glycerol into the submucosal (sm) layer, a circumferential incision was made, and an sm dissection was performed. All lesions were determined to be intramucosal or sm superficial, without lymph-node metastasis by EUS before treatment. Main Outcome Measurements Tumor size, en bloc resection rate, tumor-free lateral margin rates, and complications were recorded. Results All 4 ESD cases were successfully resected en bloc, and the tumor-free lateral margin rate was 75% (3/4) by histopathology examination. The mean tumor size of the resected specimens was 35 mm (range, 15-50 mm). There were no complications. Limitations The number of ESDs in our series was limited, and there are no long-term follow-up data. Conclusions ESD for recurrent or residual superficial esophageal tumors after chemoradiotherapy achieves the goal of an en bloc resection, with a low rate of incomplete treatment without any greater risk than the EMR technique.