Feasibility and safety of endoscopic submucosal dissection for superficial cancer of the remnant esophagus after esophagectomy.

Background: Endoscopic treatment for second primary malignancies after esophagectomy has been increasingly performed; however, evidence regarding the outcomes of endoscopic submucosal dissection (ESD) for superficial cancer of the remnant esophagus after esophagectomy (SCREE) is limited.

Methods: We retrospectively extracted cases of ESD for SCREE from our institutional database, which included 739 consecutive esophageal ESD procedures performed between January 2009 and September 2023. Information on prior treatment, clinical features of the lesions, and outcomes was evaluated.

Results: Overall, 20 patients (median age: 74 years) with 27 lesions were enrolled. ESD was performed at a median of 15 months after esophagectomy. All lesions were flat, with a median tumor diameter of 12 mm. The median ESD procedure time was 70 min. En bloc resection was achieved for all 27 lesions, with one minor perforation complication. The R0 resection rate was 96% (26 of 27). Endoscopic balloon dilation (EBD) of the anastomotic site at the beginning of ESD was required in 30% (8 of 27) of the cases. Among them, EBD was significantly more frequently performed in cases after partial esophagectomy (64%, 7 of 11) than in cases after other types of surgery. The resection speed was significantly faster in lesions after total pharyngo-laryngo-esophagectomy and slower in lesions after subtotal esophagectomy, located in the upper region, and near the anastomosis.

Conclusions: Our study demonstrated the feasibility of ESD for SCREE although EBD or a longer procedure duration may be required depending on the pre-ESD surgical technique and location of the lesions.