Prognosis after endoscopic resection of T1a-MM/T1b-SM1 esophageal squamous cell carcinoma Young Award

The ESD/EMR guidelines for esophageal squamous cell carcinoma (ESSC) recommend additional surgical resection or chemoradiotherapy (CRT) for pT1a-MM with lymphovascular invasion (LVI) and pT1b-SM1. However, in pT1a-MM without LVI, the need for additional treatment is still controversial.
In our institution, additional treatment was performed for pT1a-MM with LVI and pT1b-SM1, but  careful follow-up examinations have been conducted for those with pT1a-MM ESCC without LVI. In this study, we investigated the prognosis of p-MM/SM1 ESCC patients who underwent endoscopic resection (ER) between January 2002 and December 2020 at our hospital, which could be followed up.
99 eligible MM/SM1 cases (MM: 76, SM1: 23) were extracted out of 891 ER cases. Additional treatment was performed in 16 MM cases (21.1%) and 14 SM1 cases (60.8%). MM without LVI cases accounted for 73.7%  (56 cases), and two of them (3.6%) showed metastatic recurrence. One case had recurrence of lymph node and liver metastasis 253 days after ER and  chemotherapy was done, but died 527 days after ER. In the other case, right paratracheal LN swelling and suspicion of tracheal invasion was observed after 1720 days after ER, and chemotherapy is still ongoing. Although the recurrence rate for pT1a-MM without LVI ECCS cases is low, such recurrence can be life-threatening, so careful consideration is needed when deciding whether to perform additional treatment.