Outcomes of endoscopic submucosal dissection and esophagectomy for early and superficial carcinoma of the esophagus

Background. Endoscopic resection was recommended as treatment for mucosal epithelium or lamina propria mucosae lesions not exceeding two-thirds of the circumference. The aim of this study was to verify the outcomes of endoscopic resection and surgery for early and superficial carcinoma of the esophagus. Methods. Endoscopic submucosal dissection (ESD) was performed for 56 cases of early and superficial esophageal carcinoma and esophagectomy (OP) for 35 cases, which were enrolled in this study. Treatment-related complications, site of recurrence, and cause of death were compared. Results. The complications of ESD were esophageal perforation in six cases (11%). No bleeding and one cicatricial stenosis occurred. The complications of OP were temporary hoarseness in four cases (11%), with aspiration pneumonia in three cases (9%) and anastomotic leakage in two cases (6%), all nonfatal. All early cases of ESD survived without recurrence. One of five cases infiltrating the submucosa had mediastinal lymph node recurrence and died of metastasis to the spinal cord. Nine cases of OP for lesions from the mucosal epithelium to invasion of the upper third of the submucosa survived without recurrence. Conclusions. For mucosal epithelium or lamina propria mucosae lesions, ESD was the first choice of treatment. For muscularis mucosae lesions, the indication of ESD was allowable. For lesions infiltrating the upper third of the submucosa, one of five cases had lymph node recurrence after ESD, and two cases of radical esophagectomy were alive without recurrence.