Multi-institutional questionnaire on treatment strategies for superficial entire circumferential esophageal squamous cell carcinoma

Tomohiro Kadota; Ryu Ishihara; Waku Hatta; Masao Yoshida; Hiromitsu Kanzaki; Daisuke Kikuchi; Yoichiro Ono; Seiichiro Abe; Yoshinobu Yamamoto; Toshiyuki Yoshio; Yuji Urabe; Naoyuki Yamaguchi; Yasuaki Nagami; Toshiro Iizuka; Hiroaki Takahashi; Tsuneo Oyama; Tomonori Yano

doi:10.1002/deo2.206

Multi-institutional questionnaire on treatment strategies for superficial entire circumferential esophageal squamous cell carcinoma

DEN Open. 2023 Jan 17;3(1):e206. doi: 10.1002/deo2.206. eCollection 2023 Apr.

Authors

Tomohiro Kadota¹, Ryu Ishihara², Waku Hatta³, Masao Yoshida⁴, Hiromitsu Kanzaki⁵, Daisuke Kikuchi⁶, Yoichiro Ono⁷, Seiichiro Abe⁸, Yoshinobu Yamamoto⁹, Toshiyuki Yoshio¹⁰, Yuji Urabe¹¹, Naoyuki Yamaguchi¹², Yasuaki Nagami¹³, Toshiro Iizuka¹⁴, Hiroaki Takahashi¹⁵, Tsuneo Oyama¹⁶, Tomonori Yano¹

Affiliations

¹ Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan.
² Department of Gastrointestinal Oncology Osaka International Cancer Institute Osaka Japan.
³ Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan.
⁴ Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan.
⁵ Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan.
⁶ Department of Gastroenterology Toranomon Hospital Tokyo Japan.
⁷ Department of Gastroenterology Fukuoka University Chikushi Hospital Fukuoka Japan.
⁸ Endoscopy Division National Cancer Center Hospital Tokyo Japan.
⁹ Department of Gastrointestinal Oncology Hyogo Cancer Center Hyogo Japan.
¹⁰ Department of Gastroenterology Cancer Institute Hospital Tokyo Japan.
¹¹ Division of Regeneration and Medicine Center for Translational and Clinical Research Hiroshima University Hospital Hiroshima Japan.
¹² Department of Gastroenterology and Hepatology Nagasaki University Hospital Nagasaki Japan.
¹³ Department of Gastroenterology Osaka City University Graduate School of Medicine Osaka Japan.
¹⁴ Department of Gastroenterology Tokyo Metropolitan Cancer and infectious Diseases Center Komagome Hospital Tokyo Japan.
¹⁵ Department of Gastroenterology Keiyukai Daini Hospital Hokkaido Japan.
¹⁶ Department of Endoscopy Saku Central Hospital Advanced Care Center Nagano Japan.

Abstract

Objectives: Recent innovations in prophylactic treatment with steroids have overcome the issue of esophageal stricture after endoscopic submucosal dissection (ESD), except in entire circumferential esophageal squamous cell carcinoma (EC-ESCC). Current Japanese guidelines weakly recommend performing ESD for clinical epithelial/lamina propria EC-ESCC with a longitudinal extension <50 mm upon implementing prophylactic treatment against stricture. However, the accurate indications for ESD in EC-ESCC remain unknown, and strategies differ among institutions. The aim of this study was to understand the initial treatment strategy for EC-ESCC and prophylactic treatment after ESD against esophageal stricture.

Methods: A questionnaire survey was conducted across 16 Japanese high-volume centers on the initial treatment for EC-ESCC according to the invasion depth and longitudinal extension, and prophylactic treatment against stricture.

Results: ESD was performed as the initial treatment not only in clinical epithelial/lamina propria lesions <50 mm (88-94% of institutions), but also in clinical epithelial/lamina propria ≥50 mm (44-50% of institutions) and clinical muscularis mucosae/SM1 (submucosal invasion depth invasion within 200 μm) lesions <50 mm (56-75% of institutions). Regarding prophylactic treatment against esophageal stricture, although there was a common point of local steroid injection, the details and administration of other treatments varied among institutions.

Conclusions: As ESD was performed with expanded indications for EC-ESCC than those recommended by the guidelines in more than half of the institutions, the validity of ESD for expanded EC-ESCC needs to be clarified. For that, it is necessary to prospectively collect short- and long-term outcomes after ESD and other treatments, including esophagectomy or chemoradiotherapy.

Keywords: chemoradiotherapy; endoscopic submucosal dissection; entire circumferential esophageal squamous cell carcinoma; esophagectomy; local steroid injection.