# Clinical outcomes of circumferential endoscopic submucosal dissection in esophageal squamous cell carcinoma > 50 mm: Retrospective cohort study

## TL;DR

This study shows that endoscopic submucosal dissection for large esophageal tumors is safe and effective, with similar outcomes to smaller tumors.

## Contribution

Demonstrates the feasibility of WC-ESD for ESCC > 50 mm with comparable safety and survival outcomes.

## Key findings

- Stricture incidence was not significantly different between tumor sizes > 50 mm and ≤ 50 mm.
- Prophylactic dilation plus steroids reduced refractory strictures significantly.
- Long-term survival outcomes were comparable between tumor size groups for early-stage ESCC.

## Abstract

This study aimed to assess both short-term safety and long-term outcomes of whole circumferential endoscopic submucosal dissection (WC-ESD) for esophageal squamous cell carcinoma (ESCC) with tumor length > 50 mm, and to evaluate effectiveness of aggressive prophylactic dilation combined with steroid therapy in preventing esophageal stricture.

A retrospective review was conducted on 67 patients who underwent WC-ESD for superficial ESCC between 2009 and 2019 at a single Japanese center. Patients were categorized into > 50-mm and ≤ 50-mm groups. The primary endpoint was incidence of post-ESD stricture in the main analysis excluding surgery/chemoradiotherapy cases within 90 days; sensitivity analysis included all patients. Secondary endpoints were number of dilations, steroid use, and long-term survival outcomes (overall survival [OS], disease-specific survival [DSS], relapse-free survival [RFS]).

Stricture incidence was not significantly different (> 50 mm vs. ≤ 50 mm: 13% vs. 18%,
P
= 0.708; sensitivity: 21% vs. 15%,
P
= 0.538). Although dilations were more frequent in the > 50-mm group (96% vs. 83%), median sessions were similar (8 vs. 7.5). Prophylactic dilation plus steroids reduced refractory strictures (25%→7%,
P
= 0.03). For pT1a-EP/LPM cases, 5-year OS, DSS, and RFS were 100% in both groups. In pT1a-MM/pT1b cases, survival was comparable, although OS tended to be lower with > 50-mm lesions (68.9% vs. 100%,
P
= 0.07).

WC-ESD for superficial ESCC with a tumor length > 50 mm did not increase adverse events and provided comparable long-term survival. These findings support feasibility beyond guideline limits and emphasize further refinement of stricture prevention.