Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video)

Background Endoscopic submucosal dissection (ESD) was originally developed in Japan for en bloc resection of gastric neoplasms. Objective To clarify whether the novel ESD procedure is feasible and gives results that justify the pursuit of integrated minimally invasive procedures aimed at curing early squamous cell carcinoma of the esophagus (SCCE). Design Retrospective cohort study. Setting A single-institution trial by experienced endoscopists. Patients This study involved 300 consecutively enrolled patients with SCCE (Tumor, Nodes, Metastasis classification T1, N0) who underwent either EMR (n = 184) or ESD (n = 116) from March 1994 to July 2007. Intervention The patients underwent endoscopic resection and then were followed by periodic endoscopy for 8 to 174 months (mean 65 months). Main Outcome Measurements Resectability, cure rates, complications, disease-free survival of the two groups, and risk factors for local recurrence were explored. Results En bloc resection and the local recurrence rate were significantly better in the ESD group ( P = .0009 and .065, respectively). The frequency of perforation was not significantly different between the two groups ( P = .68). Four independent risk factors for local recurrence were identified by the Cox regression model: EMR, deep cancer invasion, upper esophagus location, and family history of esophageal cancer. Radical cure is mostly obtained by successful endoscopic retreatment of local recurrence after previous endoscopic resection. Disease-free survival was significantly better with ESD. Limitations The study's retrospective nature prevents definitive conclusions. Conclusions We provide evidence that ESD gives a higher cure rate and is safer than conventional endoscopic resection when applied to early SCCE. ESD warrants prospective comparative studies with conventional endoscopic resection.