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The Up-to-Date of Endoscopic Submucosal Dissection (ESD) in Early Cancers
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The Up-to-Date of Endoscopic Submucosal Dissection (ESD) in Early Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 6022

Special Issue Editor

Prof. Dr. Hajime Isomoto

E-Mail Website
Guest Editor
Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
Interests: narrow-band imaging (NBI); blue laser imaging (BLI); linked color imaging (LCI); image-enhanced endoscopies (IEE); artificial intelligence (AI); computer-aided diagnosis (CAD); endoscopic submucosal dissection (ESD); endocytoscopy
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Special Issue Information

Dear Colleagues,

Endoscopic Submucosal Dissection (ESD) for dysplastic lesions or early stages of cancer with nominal risks of lymph nodal metastasis could be established as the mainstay for whole digestive tract tumors from the larynx to the anorectum with sufficient curability and survival benefits. Its applications comparting peroral endoscopic tumor resections and full-layer thickness resection have been emerging even for submucosal tumors. A plethora of contrivance techniques can be used dependent on the lesions, including injection solutions, counter traction, and suturing device and employing 3-dimmension visualization. However, dependent on the lesions or anatomical locations, innovative endoluminal procedures are still related to substantial complications, such as postoperative bleeding, in particular after gastric ESD in patients receiving antithrombotic drugs, perforations following ESD in the thin mural intestines, or potentially linked to full-layer thickness resection, which are sometimes life-threatening, and luminal strictures after extensive esophageal ESD frequently compromising QOL. Prophylactic or recovery methods for those complications have been reported but are not always satisfactory. When considering treatment, achieving a cure for the tumor is regarded as critical. However, as the main cause of mortality in elderly patients after curative sections is noncancer-related death, in elderly patients and/or those with severe underlying diseases, additional surgery should be considered carefully when selecting a post-ESD treatment strategy for patients undergoing non-curative resection. Accumulating retrospective and prospective data is needed to resolve such remaining issues even within the maturation of technical aspects and is the focus of this Special Issue, “ESD to Date”, where we would like to summarize the most recent studies on gastrointestinal ESD from the standpoint of earlier cancer management and perspectives to resolve various issues in the context of an increasingly aging society.

Prof. Dr. Hajime Isomoto
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endoscopic submucosal dissection (ESD)
  • early GI cancer
  • dysplasia
  • full-layer thickness resection
  • antithrombotic drugs
  • esophageal stenosis
  • non-curative resection
  • survival benefits
  • cancer-specific survival
  • elderly

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Published Papers (3 papers)

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Research

11 pages, 1205 KiB  
Article
Outcome of Completion Surgery after Endoscopic Submucosal Dissection in Early-Stage Colorectal Cancer Patients
by Nik Dekkers, Hao Dang, Katinka Vork, Alexandra M. J. Langers, Jolein van der Kraan, Marinke Westerterp, Koen C. M. J. Peeters, Fabian A. Holman, Arjun D. Koch, Wilmar de Graaf, Paul Didden, Leon M. G. Moons, Pascal G. Doornebosch, James C. H. Hardwick and Jurjen J. Boonstra
Cancers 2023, 15(18), 4490; https://doi.org/10.3390/cancers15184490 - 9 Sep 2023
Cited by 3 | Viewed by 1433
Abstract
T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this [...] Read more.
T1 colorectal cancers (T1CRC) are increasingly being treated by endoscopic submucosal dissection (ESD). After ESD of a T1CRC, completion surgery is indicated in a subgroup of patients. Currently, the influence of ESD on surgical morbidity and mortality is unknown. The aim of this study was to compare 90-day morbidity and mortality of completion surgery after ESD to primary surgery. The completion surgery group consisted of suspected T1CRC patients from a multicenter prospective ESD database (2014–2020). The primary surgery group consisted of pT1CRC patients from a nationwide surgical registry (2017–2019). Patients with rectal or sigmoidal cancers were selected. Patients receiving neoadjuvant therapy were excluded. Propensity score adjustment was used to correct for confounders. In total, 411 patients were included: 54 in the completion surgery group (39 pT1, 15 pT2) and 357 in the primary surgery group with pT1CRC. Adverse event rate was 24.1% after completion surgery and 21.3% after primary surgery. After completion surgery 90-day mortality did not occur, though one patient died in the primary surgery group. After propensity score adjustment, lymph node yield did not differ significantly between the groups. Among other morbidity-related outcomes, stoma rate (OR 1.298 95%-CI 0.587-2.872, p = 0.519) and adverse event rate (OR 1.162; 95%-CI 0.570-2.370, p = 0.679) also did not differ significantly. A subgroup analysis was performed in patients undergoing rectal surgery. In this subgroup (37 completion and 136 primary surgery), these morbidity outcomes also did not differ significantly. In conclusion, this study suggests that ESD does not compromise morbidity or 90-day mortality of completion surgery. Full article
(This article belongs to the Special Issue The Up-to-Date of Endoscopic Submucosal Dissection (ESD) in Early Cancers)
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12 pages, 1569 KiB  
Article
Association between Submucosal Fibrosis and Endoscopic Submucosal Dissection of Recurrent Esophageal Squamous Cell Cancers after Chemoradiotherapy
by Tsunetaka Kato, Takuto Hikichi, Jun Nakamura, Minami Hashimoto, Ryoichiro Kobashi, Takumi Yanagita, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Mika Takasumi, Yuka Oka, Tadayuki Takagi, Yuko Hashimoto, Masao Kobayakawa and Hiromasa Ohira
Cancers 2022, 14(19), 4685; https://doi.org/10.3390/cancers14194685 - 26 Sep 2022
Cited by 4 | Viewed by 1944
Abstract
Endoscopic resection is a treatment of choice for a metachronous early-stage esophageal squamous cell carcinoma (ESCC) appearing after a radical cure of esophageal cancer by chemoradiotherapy (CRT). However, non-curative resection, and procedural complications including perforation due to radiation-induced submucosal fibrosis, are a concern. [...] Read more.
Endoscopic resection is a treatment of choice for a metachronous early-stage esophageal squamous cell carcinoma (ESCC) appearing after a radical cure of esophageal cancer by chemoradiotherapy (CRT). However, non-curative resection, and procedural complications including perforation due to radiation-induced submucosal fibrosis, are a concern. This study aimed to evaluate the association between submucosal fibrosis and the usefulness and safety of endoscopic submucosal dissection (ESD) in ESCC after CRT. This study retrospectively analyzed 13 lesions in 11 patients in our institute. Submucosal fibrosis under the lesion (F score) was classified into three levels (F0: none or mild, F1: moderate, and F2: severe) based on endoscopic and histopathologic findings. All lesions were F1 or greater (F1: 8 lesions and F2: 5 lesions). En bloc and R0 resection rates were both 100%. The procedural speed was slower in F2 than in F1 (F1 vs. F2; 15.1 mm2/min vs. 7.1 mm2/min, p = 0.019), without procedure-related adverse events. At a median follow-up of 42 months (range: 14–117 months) after ESD, 7 of 11 (63.6%) patients were alive without recurrence, and without ESCC-related death. ESCC after CRT reliably and safely resected en bloc by ESD but was more difficult in lesions with strong submucosal fibrosis. Full article
(This article belongs to the Special Issue The Up-to-Date of Endoscopic Submucosal Dissection (ESD) in Early Cancers)
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13 pages, 1491 KiB  
Article
The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years
by Takaaki Yoshikawa, Atsushi Yamauchi, Ryuhei Hamasaki, Yuki Mori, Kazuki Osawa, Ryo Ito, Yuya Kawai, Souta Nakagami, Shunjiro Azuma, Toshihiro Morita, Kenshiro Hirohashi, Katsutoshi Kuriyama, Ken Takahashi, Tadayuki Kou, Hiroshi Kondoh and Shujiro Yazumi
Cancers 2022, 14(14), 3311; https://doi.org/10.3390/cancers14143311 - 7 Jul 2022
Cited by 2 | Viewed by 1873
Abstract
Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged ≥85 years is unclear. The patients enrolled in this study were [...] Read more.
Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged ≥85 years is unclear. The patients enrolled in this study were divided into three groups: age ≥85 years (44 patients, 49 lesions), age 65–84 years (624 patients, 687 lesions), and age ≤64 years (162 patients, 174 lesions). We evaluated the incidence of adverse events (AEs) and overall survival (OS) and disease-specific survival (DSS). We analyzed the factors that had a significant impact on the prognosis of patients aged ≥85 years. No significant differences were found in the incidence of AEs among the three groups (p = 0.612). The OS was significantly lower in patients aged ≥85 years (p < 0.001). Conversely, DSS was not significantly worse in patients aged ≥85 years (p = 0.100). The poor Geriatric Nutritional Risk Index correlated with poor prognosis in patients aged ≥85 years (p < 0.001). ESD is a safe and valid treatment for EGC in patients aged ≥85 years. However, the indications should be carefully decided because it is difficult to estimate the survival contribution of ESD for EGC in patients aged ≥85 years, especially in those with poor nutritional status. Full article
(This article belongs to the Special Issue The Up-to-Date of Endoscopic Submucosal Dissection (ESD) in Early Cancers)
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