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The incidence of esophageal squamous cell carcinoma (ESCC) has been divided by 3 in France over the last 30 years, but this tumor remains associated with a poor prognosis. The main prognostic factor is the tumor stage at the time of diagnosis. ESCC does not cause any symptom in its early stages and is often diagnosed at an advanced stage: less than 10 % of ESCCs are diagnosed at a localized stage (≤ T2). No screening program exists in France nationwide or in high-risk individuals. Early (T1) ESCCs are eligible for endoscopic resection by endoscopic submucosal dissection (ESD), which is as effective as surgery in terms of overall survival and recurrence-free survival, and associated with a much lower morbidity and mortality. ESD is considered curative in case of an en-bloc resection, histologically complete, and with a limited metastatic risk, as evaluated based on histopronostic factors present on the resection specimen. In case of positive deep resection margins, deep submucosal invasion, poorly differentiated tumor, or lymphatic and/or vascular invasion, the resection is considered non-curative and further treatment should be considered. After each ESD for superficial ESCC, the need for further treatment is discussed at a dedicated tumor board, weighting the risk of metastases against the patient's age and co-morbid conditions, and the risks associated with the treatment. [ABSTRACT FROM AUTHOR]

Early gastrointestinal cancers or T1 cancers are limited to the mucosa or the submucosa. Virtually all of these tumors are eligible to a complete endoscopic resection by endoscopic mucosal resection or submucosal dissection, allowing avoiding upfront surgical resection. However, endoscopic technical difficulties or uncertainties in endoscopic histological prediction can lead to histologically incomplete resections, requiring salvage treatment. Other tumors, although entirely resected, are considered to have a significant risk of metastasis, warranting adjuvant therapy, depending on histological criteria on the resection specimen. The management of these lesions needs to take into account several parameters, among which the patient comorbid conditions, wishes, endoscopic resection modality, lesion location, qualitative and quantitative histological criteria. This is the role of a multidisciplinary tumor board dedicated to early gastrointestinal cancers. Involving gastrointestinal endoscopists, oncologists, digestive surgeons, pathologists, radiation oncologists and radiologists, its aims at stating the curative nature of the endoscopic resection procedure, or indicating additional treatments. [ABSTRACT FROM AUTHOR]