JGH Open (Apr 2020)

Effect of horizontal margin status and risk of local recurrence after endoscopic submucosal dissection for superficial esophageal cancer

  • Hiromu Fukuda,
  • Ryu Ishihara,
  • Yusaku Shimamoto,
  • Mitsuhiro Kono,
  • Kentaro Nakagawa,
  • Masayasu Ohmori,
  • Kenshi Matsuno,
  • Hiroyoshi Iwagami,
  • Shuntaro Inoue,
  • Taro Iwatsubo,
  • Hiroko Nakahira,
  • Noriko Matsuura,
  • Satoki Shichijo,
  • Akira Maekawa,
  • Takashi Kanesaka,
  • Yoji Takeuchi,
  • Koji Higashino,
  • Noriya Uedo,
  • Masanori Kitamura,
  • Shinichi Nakatsuka

DOI
https://doi.org/10.1002/jgh3.12233
Journal volume & issue
Vol. 4, no. 2
pp. 160 – 165

Abstract

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Background and Aim Endoscopic submucosal dissection (ESD) sometimes results in en bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. The specific risk for such situations is unclear. We therefore investigated the outcome of ESD with HM1 or HMX. Methods This single‐center retrospective study was performed at Osaka International Cancer Institute. A total of 886 esophageal squamous cell carcinoma lesions in 749 patients treated from April 2005 to June 2015 were evaluated according to the following inclusion criteria: en bloc resection with no residual lesion, HM1 or HMX status, no prior treatment, and no additional treatment. We classified HM1 and HMX into type A, in which cancer was exposed on the HM, and type B, in which the HM status was unclear because of mechanical or thermal damage. We further classified type B according to the distance between the cancer and the edge of the specimen: type B1, <1 mm and type B2, ≥1 mm. Results The resection margin was judged as HM1 or HMX in 5.0% (39/767; 95% confidence interval, 3.5–6.6%) of the en bloc resected specimens. Of 39 lesions, 30 fulfilled the inclusion criteria. Local recurrence developed in 8 of 30 lesions (26.7%). The local recurrence rates for types A, B1, and B2 were 40% (6/15 lesions), 28.5% (2/7 lesions), and 0.0% (0/8 lesions), respectively. Conclusions Although a statistical analysis was not conducted because of the limited events, the pathological HM status may be a useful predictor of local recurrence.

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