OA03-RF01.05. The Safety and Efficacy of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Carcinoma in Scandinavia (SEES-Study)

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Endoscopic submucosal dissection (ESD) is recommended for early-stage esophageal squamous cell carcinoma (ESCC). Most data on the efficacy of ESD for ESCC comes from Asia. There are no studies from Scandinavia. The aim of this study was to evaluate the safety and efficacy of ESD for ESCC in Scandinavia. Methods A multicenter retrospective cohort study. All patients with ESCC treated with ESD at five specialized centers in Sweden, Norway, Denmark and Iceland between January 2010 - June 2024 were included. The primary outcome was technical success rate - complete resection and en bloc resection. The secondary outcomes were R0 and curative resection rates, adverse events, overall survival (OS), disease-specific survival (DSS). Results Fifty-four patients were included, with a median age of 73 (IQR 67-79). The tumors involved ≥ 75% of the lumen circumference in 50.0 % of cases. The procedures were performed under general anesthesia and median operation time was 120.5 (IQR 81-180) minutes. The median hospital-stay was 2.5 days. Regarding primary outcomes, complete resection and en bloc resection rates were 98.2 % and 96.3 %, respectively. As for secondary outcomes, R0 and curative rates were 69.8 % and 44.4 %. One patient (1.9 %) had a postoperative bleeding, and one had a perforation. Stricture occurred in 33.3 %. One patient died within 30-days due to a delayed gastric perforation caused by barotrauma. With median follow-up of 2.6 years, five patients (9.3 %) died of ESCC and 11 (20.4 %) of other causes. Five-year OS and DSS were 60.3 % and 83.4 %. Conclusion Even in Scandinavia, with a low incidence of ESCC, ESD is a safe and effective treatment. A large proportion of tumors were large circumferential lesions, which could be removed completely, and the hospital stay was short. Compared to Asian series, good rates of complete and en bloc resection rates were achieved, however with lower curative resection rates, indicating that more advanced tumors were resected. During follow-up, <10% of treated patients died due to ESCC.