Endoscopic Submucosal Dissection with/without Adjuvant Therapy for the Treatment of cT1N0M0 Esophageal Neoplasms Turned Out to be pT1b Cancers after the Endoscopic Resection

Background and Aim: After endoscopic submucosal dissection (ESD) for esophageal neoplasms, some patients would have the diagnosis of submucosal (pT1b) cancers. How to manage these patients appropriately after the ESD has not been well elucidated. The aim of this study is to report the outcomes of the patients with pT1b esophageal cancers, with or without adjuvant therapy after the ESD. Patients and Methods: This is a retrospective observational study. Between May 2013 and November 2017, 23 patients (25 lesions) undergoing ESD with the results of pT1b esophageal squamous cell carcinomas were enrolled in this study. After the ESD, our protocol was to give the patients adjuvant therapy (surgery or chemoradiotherapy) for the following criteria: positive vertical resection margins,lymphovascular (LV) invasion in the resected specimens, and SM2 cancers (tumor invasion to submucosa deeper than 200 μm). Those patients did not meet the criteria or refused adjuvant therapy were followed-up closely. Results: The mean patient age was 56.3 year (range, 45-75 year). The mean resected specimen length was 4.6 cm (range, 1.5-9.5 cm). The en block resection rate for the ESD was 100%. Four patients had positive vertical resection margins, resulting in an en blockplus R0 resection rate of 82.6% (19/23). Four other patients had LV invasion in the resected specimens. These eight patients (34.8%) were regarded as incomplete treatment by the ESD and seven of them received adjuvant therapy. None had tumor recurrence during the mean follow-up of 30.1 months. Two of the remaining 15 patients with R0 resection without LV invasion eceived adjuvant therapy based on the protocol. The other 13 patients received close observations only, including 11 patients with SM2 cancers. None had tumor recurrence during the mean follow-up of 23.6 months. Conclusions: ESD with/without adjuvant therapy based on the final pathological results may be an alternative treatment for patients with pT1b esophageal cancers.