Elsevier

Gastrointestinal Endoscopy

Volume 61, Issue 2, February 2005, Pages 219-225
Gastrointestinal Endoscopy

Original Article
Local recurrence of squamous-cell carcinoma of the esophagus after EMR

https://doi.org/10.1016/S0016-5107(04)02756-7Get rights and content

Background

Multicentric squamous dysplasia is frequent in the esophagus and can be visualized by chromoendoscopy (Lugol's solution) as multiple Lugol-voiding lesions (LVLs). Although EMR commonly is used to treat superficial esophageal cancer, new lesions can arise and incomplete resection can result in residual disease. Little is known about the risk factors for local recurrence or the appropriate treatment for recurrent lesions.

Methods

A total of 116 consecutive patients with a total of 165 esophageal squamous-cell carcinomas were studied retrospectively. Follow-up examination by means of chromoendoscopy (Lugol's solution) and biopsies was performed every 3 months during the first year after EMR and every 6 months thereafter. Lesions were defined as a local recurrence when cancer was detected at the site of the EMR scar. Risk factors associated with local recurrence were investigated by using logistic analysis.

Results

At a median follow-up of 35 months (range 12-110 months), local recurrence was detected for 33 (20%) of 165 lesions. Of the patient-related factors, multivariate logistic analysis showed that multiple LVLs (OR 3.1: 95% CI[1.1, 8.5]; p = 0.03) was an independent risk factor for local recurrence after EMR. The cumulative local recurrence rates at 3 years in patients with multiple LVLs and those without multiple LVLs were 39% and 14% (p < 0.01), respectively. All of the recurrent lesions except two could be removed by EMR, which was not associated with any serious complication. The remaining two patients had chemoradiotherapy. Overall cause-specific survival at 3 years was 100%.

Conclusions

Patients with multiple LVLs are at risk of local recurrence after EMR. Although careful long-term endoscopic follow-up is needed for such patients, EMR is potentially curative for recurrent lesions.

Section snippets

Patients and methods

A total of 229 consecutive patients with esophageal cancer underwent EMR between February 1993 and March 2002. Among them, 116 patients, with a total of 165 lesions, who met the following criteria were included in the present retrospective study: (1) newly diagnosed squamous-cell carcinoma of the esophagus, (2) tumor invasion histopathologically confined to the mucosal layer, (3) no prior treatment, (4) no additional treatment immediately after EMR, and (5) follow-up longer than 1 year. Written

Results

Patient characteristics are shown in Table 1. The study group included 116 patients (103 men, 13 women; mean age 64 [8.8] years). Forty-two patients (36.2%) had synchronous or metachronous multiple cancers in the head and neck region, and 24 (20.7%) had synchronous or metachronous multiple cancers in the esophagus. Mean tumor size was 20.5 (15.7) mm. The tumor location was as follows: proximal third of the esophagus, 22 lesions (13.3%); middle third, 88 (53.3%); and distal third, 55 (33.3%).

Discussion

EMR is well recognized as a standard treatment for superficial esophageal cancer. Clinically, local recurrence after EMR is an important issue with respect to curative treatment and has been reported to occur in 2.4% to 7.8% of cases.22, 23, 24 However, a significant predictor of local recurrence and the optimal curative treatment for such lesions have not been described.

The results of the present study show that multiple LVLs are an independent risk factor for local recurrence. Indeed, when

References (26)

  • M. Muto et al.

    Association of aldehyde dehydrogenase 2 gene polymorphism with multiple esophageal dysplasia in head and neck cancer patients

    Gut

    (2000)
  • M.D. Dawsey et al.

    Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China

    Cancer

    (1998)
  • H. Inoue et al.

    Lugol chromoendoscopy for esophageal squamous cell cancer

    Endoscopy

    (2001)
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