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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2021

01-12-2021 | Esophagus Resection | Thoracic Oncology

Additional Treatment Following Noncurative Endoscopic Resection for Esophageal Squamous Cell Carcinoma: A Comparison of Outcomes between Esophagectomy and Chemoradiotherapy

Authors: Yasukazu Kanie, MD, Akihiko Okamura, MD, PhD, Takao Asari, MD, Suguru Maruyama, MD, PhD, Kei Sakamoto, MD, Daisuke Fujiwara, MD, PhD, Jun Kanamori, MD, PhD, Yu Imamura, MD, PhD, FACS, Akiyoshi Ishiyama, MD, Toshiyuki Yoshio, MD, PhD, Tomohiro Tsuchida, MD, PhD, Keisho Chin, MD, Masayuki Watanabe, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 13/2021

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Abstract

Background

Endoscopic resection (ER) has been widely implemented for cT1N0 esophageal squamous cell carcinoma (ESCC). Additional therapy, including esophagectomy and chemoradiotherapy (CRT), is sometimes required after noncurative ER.

Methods

We retrospectively reviewed 108 patients who received any additional treatment following noncurative ER (positive vertical margins, lymphovascular invasion, or invasion depth of submucosa or more), and compared the short- and long-term outcomes between the two treatment modalities.

Results

Of 108 patients, 56 underwent esophagectomy (E group), and 52 received CRT (CRT group). A positive vertical margin was observed in 17 (14.8%) patients and high risks of occult lymph node metastasis were observed in 91 (85.2%) patients, as well as lymphovascular invasion in 35 (32.4%) patients, invasion depth of the submucosa or more in 27 (25.0%) patients, and both in 29 (26.9%) patients. The E group patients were significantly younger (p = 0.046) and tended to present with larger tumors than those in the CRT group (p = 0.057). Lymphatic invasion was more frequent in the E group (p = 0.019), and, furthermore, one treatment-related death was observed in the E group. There were no significant differences between the groups in overall and disease-specific survival (p = 0.406 and 0.151, respectively), however, recurrence was only observed in the CRT group.

Conclusion

Both esophagectomy and CRT are safe and effective as additional treatments after noncurative ER in patients with ESCC. Esophagectomy is oncologically safe, whereas a risk of postoperative morbidity and mortality remains. Although the adverse events are acceptable, CRT has a certain degree of risk of disease recurrence.
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Metadata
Title
Additional Treatment Following Noncurative Endoscopic Resection for Esophageal Squamous Cell Carcinoma: A Comparison of Outcomes between Esophagectomy and Chemoradiotherapy
Authors
Yasukazu Kanie, MD
Akihiko Okamura, MD, PhD
Takao Asari, MD
Suguru Maruyama, MD, PhD
Kei Sakamoto, MD
Daisuke Fujiwara, MD, PhD
Jun Kanamori, MD, PhD
Yu Imamura, MD, PhD, FACS
Akiyoshi Ishiyama, MD
Toshiyuki Yoshio, MD, PhD
Tomohiro Tsuchida, MD, PhD
Keisho Chin, MD
Masayuki Watanabe, MD, PhD, FACS
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-10225-5

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