Zhang Y, et al. - Researchers comparatively analyzed the outcomes of patients with early-stage esophageal squamous cell carcinoma (EESCC) treated with endoscopic submucosal dissection (ESD) vs esophagectomy from October 1, 2011 through September 31, 2016 at Zhongshan Hospital in Shanghai, China. Results showed that lower proportions of patients receiving ESD presented with perioperative adverse events or disease-specific mortality after a median follow up time of 21 months. No variation was discovered in the overall survival or cancer recurrence or metastasis in patients with T1a or T1b ESCCs treated with ESD vs esophagectomy.

Methods

• This retrospective cohort study examined patients with T1a-m2/m3, or T1b EESCCs who underwent ESD (n=322) or esophagectomy (n=274) from October 1, 2011 through September 31, 2016 at Zhongshan Hospital in Shanghai, China.
• All-cause mortality at the end of follow up (minimum of 6 months) served as the main outcome.
• Secondary outcomes consisted of operation time, hospital stay, cost, perioperative mortalities/severe non-fatal adverse events, requirement for adjuvant therapies, and disease-specific mortality and cancer recurrence or metastasis at the end of the follow up period.

Results

• Patients who underwent ESD were older (mean 63.5 years vs 62.3 years for patients receiving esophagectomy; P=.006).
• A greater proportion of enrollees were male (80.1% vs 70.4%; P=.006) and had a T1a tumor (74.5% vs 27%; P=.001).
• Findings showed that a lower proportion of patients who underwent ESD presented with a perioperative mortality (0.3% vs 1.5% of patients receiving esophagectomy; P=.186) and non-fatal severe adverse events (15.2% vs 27.7%; P=.001), particularly lower proportions of esophageal fistula (0.3% of patients receiving ESD vs 16.4% for patients receiving esophagectomy; P=.001) and pulmonary complications (0.3% vs 3.6%; P=.004).
• No significant variations were found between treatments in all-cause mortality (7.4% for ESD vs 10.9%; P=.209) or rate of cancer recurrence or metastasis (9.1% for ESD vs 8.9%; P=.948) after a median follow-up time of 21 months (range, 6-73 months).
• Decreased disease-specific mortality was reported among patients who received ESD (3.4%) vs patients who patients who received esophagectomy (7.4%) (P=.049).
• As per the Cox regression analysis, depth of tumor invasion served as the sole factor linked with all-cause mortality (T1a-m3 or deeper vs T1a-m2: hazard ration, 3.54; P=.04).