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

BackgroundTreatment of local recurrent or residual superficial esophageal squamous-cell carcinoma (SCC) with conventional EMR often results in a piecemeal resection that requires further intervention.ObjectiveThe aim of this study was to evaluate the efficacy of endoscopic submucosal dissection (ESD).DesignA case series.PatientsBetween January 2006 and September 2006, 4 local recurrent or residual superficial esophageal SCCs were treated by ESD.InterventionsESD 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 MeasurementsTumor size, en bloc resection rate, tumor-free lateral margin rates, and complications were recorded.ResultsAll 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.LimitationsThe number of ESDs in our series was limited, and there are no long-term follow-up data.ConclusionsESD 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.