Z Gastroenterol 2006; 44 - P299
DOI: 10.1055/s-2006-950903

Curative endoscopic resection in patients with early esophageal squamous cell carcinoma – an analysis of risk factors for recurrence

O Pech 1, A May 1, M Vieth 2, H Manner 1, T Rabenstein 1, L Gossner 1, J Huijsmans 1, M Stolte 2, C Ell 1
  • 1HSK Wiesbaden, Wiesbaden, Germany
  • 2Department of Pathology, Bayreuth, Germany

Objectives: Endoscopic resection (ER) of esophageal squamous-cell neoplasia (SCN) with curative intent is considered to be a save and effective alternative treatment to radical surgery in case the neoplasia is intraepithelial or limited to the mucosal layer. Anyhow, those patients (pts) are at risk for recurrent malignancy.

Design: We conducted a prospective study to evaluate the efficacy and safety of ER and to analyze variables associated with recurrence in pts with mucosal or intraepithelial SCN.

Methods: Between December 1997 and September 2005, 65 pts (mean age 62.9±9.5 years) with carcinoma in situ (Cis) (n=12) and mucosal squamous cancer (n=53) were included and were treated using ER. Detailed pts and tumor characteristics were documented prospectively. All pts were included in a staging protocol including HR-endoscopy with Lugol staining, endoscopic ultrasound, computed tomography and abdominal ultrasound. Uni- and multivariate analysis of acquired data was performed.

Results: A total of 179 ER were performed (mean 2.8±1.8). All pts with CIS (100%), and 50/53 (94%) pts with mucosal cancer achieved a complete response (CR) during a mean follow-up period of 39.3±22.8 months, 3 pts were still under therapy. Recurrence of malignancy after CR was observed in 16 (26%) pts, but all of them again achieved CR after further ER. Independent risk factors for recurrence were time until CR was achieved >14 months (relative risk (RR) 6.6; p=0.002), T1m1-tumor (RR 3.9; p=0.02) and multifocal carcinoma (RR 4.1; p=0.018). Tumor-related deaths occurred in two pts (3%), 8 pts died from co-morbidity. Complications were seen in 15 pts (23%; esophageal stenoses). Calculated 5-year survival for was 77%.

Fig. 1

Conclusions: ER appears to be an effective and safe method of curative treatment in pts with SCN on long term follow up. Multifocal carcinoma, long time until CR is achieved and T1m1 tumors seem to be highly associated with recurrence.