1. Long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell neoplasms Satoshi Ono, MD, Mitsuhiro Fujishiro, MD, PhD, Keiko Niimi, MD, Osamu Goto, MD, Shinya Kodashima, MD, PhD, Nobutake Yamamichi, MD, PhD, Masao Omata, MD, PhD (Gastrointest Endosc. 2009; 70: 860-6.) R1 Jang Na-eun Journal conference

2. BACKGROUND BACKGROUND An increasing number of early-stage, superficial, esopha- geal squamous cell neoplasm(ESCNs) has been detected recently - new diagnostic endoscopic technology ESD for early esophageal cancer is a promising treatment modality - enables a reliable en bloc resection less invasively than surgery - technical difficulties, postopertive stricture, perforation and bleeding

3. BACKGROUND BACKGROUND ESD for esophageal squamous cell carcinoma has already been established with favorable middle-term outcomes But, long term outcomes of esophageal ESD have not been elucidated so far

4. OBJECTIVES OBJECTIVES Aimed to assess a larger number of patients with longer follow up times to address the technical feasibility and long- term outcomes of ESD for ESCNs

5. METHODS METHODS A retrospective, unicentric study Between January 2002 and July 2008 107 consecutive superficial ESCNs in 84 patients Treated by ESD at the University of Tokyo Hospital The indicated lesions were diagnosed as Squamous cell carcinoma by endoscopic biopsy - exclude adenocarcinoma or other minor histopathological types, because a consensus for endoscopic treatment has not been established

6. METHODS METHODS A enrolled patients were divided into 2 groups based on the lesion with the deepest invasion Group A: HGIN or m2(lamina propria mucosa) Group B: m3(muscularis mucosa) or sm(submucosa) m3 or sm or who showed vessel infiltration were recommen- ded to have additional treatments - such as esophagectomy with lymph node dissection or radiation therapy with or without chemotherapy Follow-up endoscopy - after 2 months: check the healing state and residual tumor - after 6 and 12 months: check for local recurrence or second primary lesion

7. METHODS METHODS Main outcome measurements - short-term outcomes : rates of en bloc resection, complete resection and complication - long-term outcomes : overall survival, cause-specific survival, and post- operative stricture rate Statiscal analysis of long-term outcome - Kaplan-Meier method and log-rank test - P <0.05 was considered significant

8. RESULTS RESULTS

10. The 5-year overall/cause specific survival rates : Group A and B: 95%/100% and 56%/85%, respectively Both the overall and cause-specific survival rates of group A are significantly higher than those of group B The 5-year overall/cause specific survival rates : Group A and B: 95%/100% and 56%/85%, respectively Both the overall and cause-specific survival rates of group A are significantly higher than those of group B

11. CONCLUSIONS CONCLUSIONS Study revealed that ESD is a potentially curative treatment for superficial ESCNs ESD can surely play a central role in treatments for ESCNs