Association between Submucosal Fibrosis and Endoscopic Submucosal Dissection of Recurrent Esophageal Squamous Cell Cancers after Chemoradiotherapy

  • Tsunetaka Kato
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Takuto Hikichi
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Jun Nakamura
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Minami Hashimoto
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Ryoichiro Kobashi
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Takumi Yanagita
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Rei Suzuki
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Mitsuru Sugimoto
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Yuki Sato
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Hiroki Irie
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Mika Takasumi
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Yuka Oka
    Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Tadayuki Takagi
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Yuko Hashimoto
    Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
  • Masao Kobayakawa
    Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
  • Hiromasa Ohira
    Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan

Description

<jats:p>Endoscopic resection is a treatment of choice for a metachronous early-stage esophageal squamous cell carcinoma (ESCC) appearing after a radical cure of esophageal cancer by chemoradiotherapy (CRT). However, non-curative resection, and procedural complications including perforation due to radiation-induced submucosal fibrosis, are a concern. This study aimed to evaluate the association between submucosal fibrosis and the usefulness and safety of endoscopic submucosal dissection (ESD) in ESCC after CRT. This study retrospectively analyzed 13 lesions in 11 patients in our institute. Submucosal fibrosis under the lesion (F score) was classified into three levels (F0: none or mild, F1: moderate, and F2: severe) based on endoscopic and histopathologic findings. All lesions were F1 or greater (F1: 8 lesions and F2: 5 lesions). En bloc and R0 resection rates were both 100%. The procedural speed was slower in F2 than in F1 (F1 vs. F2; 15.1 mm2/min vs. 7.1 mm2/min, p = 0.019), without procedure-related adverse events. At a median follow-up of 42 months (range: 14–117 months) after ESD, 7 of 11 (63.6%) patients were alive without recurrence, and without ESCC-related death. ESCC after CRT reliably and safely resected en bloc by ESD but was more difficult in lesions with strong submucosal fibrosis.</jats:p>

Journal

  • Cancers

    Cancers 14 (19), 4685-, 2022-09-26

    MDPI AG

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