Endoscopic submucosal dissection of recurrent or residual superficial esophageal cancer after chemoradiotherapy.
BACKGROUND
Treatment of local recurrent or residual superficial esophageal squamous-cell carcinoma (SCC) with conventional EMR often results in a piecemeal resection that requires further intervention.


OBJECTIVE
The aim of this study was to evaluate the efficacy of endoscopic submucosal dissection (ESD).


METHODS
A case series.


METHODS
Between January 2006 and September 2006, 4 local recurrent or residual superficial esophageal SCCs were treated by ESD.


METHODS
ESD 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.


METHODS
Tumor size, en bloc resection rate, tumor-free lateral margin rates, and complications were recorded.


RESULTS
All 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.


CONCLUSIONS
The number of ESDs in our series was limited, and there are no long-term follow-up data.


CONCLUSIONS
ESD 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.
Saito
Yutaka
Y
Division of Endoscopy, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Takisawa
Hajime
H
Suzuki
Haruhisa
H
Takizawa
Kouhei
K
Yokoi
Chizu
C
Nonaka
Satoru
S
Matsuda
Takahisa
T
Nakanishi
Yukihiro
Y
Kato
Ken
K
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D009092:Mucous Membrane; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D018365:Neoplasm, Residual / Q000601:surgery*; D012008:Recurrence