Introduction
Endoscopic submucosal dissection is becoming the gold standard for the resection of superficial squamous cell carcinoma. It is unclear whether delaying esophgectomy after endoscopic submucosal dissection is better in terms of mortality and complications than primary esophgectomy in esophageal cancer patients. We compared the long-term outcomes and the complications between these two groups.
Aims & Methods
Between 2003 and 2019, 191 patients underwent primary esophagectomy and 65 patients underwent ESD then delayed esophagectomy. In a matched group of 65 pairs, OS, DSS, and RFS were compared between the 2 groups. The overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and postoperative complications were compared between the propensity-matched groups.
Results
In a matched cohort, OS, DSS, and RFS were comparable between the 2 groups. Even though the overall survival of 6 years was 70% versus 80% (p value=0.041) in the primary esophgectomy versus ESD and consequent esophgectomy respectively, DSS was 25% versus 12.5% (p value=0.21). The RFS was 80% versus 98% with p value of 0.06. In terms of recurrence free survival, differentiation, and tumor size were independent factors. When comparing adverse events between two groups there were non 60 day mortality in both groups and significant difference in early complication in the primary surgery group compared to surgery after ESD group. (47.7% versus 15.4%, p=<0.001)
Conclusion
In management for the superficial esophageal cancer, delayed surgery may have advantage in terms of survival, recurrence-free survival and complications.
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