Post written by Daiki Sato, MD, from the Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, and the Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan, and Tomohiro Kadota, MD, PhD, from the Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan. 

This study focused on the long-term clinical outcomes after endoscopic resection (ER) of pathological muscularis mucosae (pMM) superficial esophageal squamous cell carcinoma (ESCC) without lymphovascular invasion (LVI).

ER is a standard treatment for ESCC. Whether resection is curative is determined based on the pathological findings of the resected specimens. Pathological epithelium/lamina propria mucosae (pEP/LPM) without LVI has almost no risk of lymph node recurrence, so it is defined as curative resection, and follow-up after ER is recommended.

Regarding cases with LVI, even pEP/LPM/MM has a high risk of recurrence with a cumulative recurrence rate of 46.7%. Therefore, pEP/LPM/MM with LVI is regarded as a noncurative resection, and additional treatment after ER is recommended.

Regarding pMM without LVI, Japan Gastroenterological Endoscopy Society EMR/endoscopic submucosal dissection guidelines for esophageal cancer state that the proportion of lymph node recurrence is 5.6%, and the recommendation could not be concluded regarding whether to perform additional treatment. This was because these data were not regarded as high-level evidence, as several retrospective case series were tabulated without sufficient long-term follow-up.

Therefore, we felt it was important to clarify the long-term clinical outcomes of this cohort and conducted the single-center retrospective study. Our study found that the 5-year cumulative recurrence rate was 4.3% among 87 enrolled patients with pMM ESCC without LVI after ER. In addition, the 5-year disease-specific survival and overall survival rates were 98.2% and 91.7%, respectively, which were favorable outcomes. But all 3 recurrence patients died of the primary disease, and 2 of them developed recurrence more than 3 years after ER.

The recurrence rate was comparable to that in the guidelines. Thus, whether additional treatments should be performed in this cohort is still controversial. Further investigation with a larger sample size is needed to identify the risk factor for recurrence in this cohort.

In conclusion, the long-term outcome of pMM ESCC without LVI after ER was favorable. However, this population had a risk of recurrence directly leading to death. Therefore, long-term and strict follow-up of more than 3 years is necessary.

Clinical outcomes of pMM ESCC without LVI after ER. A, CRR. B, OS. C, DSS. D, Overall survival. CI, Confidence interval; CRR, cumulative recurrence rate; DSS, disease-specific survival rate; RFS, recurrence-free survival rate.

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