Treatment strategy for lateral spreading superficial esophageal squamous cell carcinoma

169 Background: ESD is the one of the options of treatment even for lateral spreading (size is over 5 cm) esophageal squamous cell carcinoma (L-S ESCC). Some patients have to undergo additional treatment because tumor is invaded to submucosal layer or lymphovascular invasion. On the other hand, wide resection by ESD could cause the delay of additional treatment because of the treatment for esophageal stricture after ESD. Thus, treatment strategy for L-S ESCC has to include additional treatment after ESD. Methods: From January 2010 to December 2014, 49 cases of l L-S ESCC were resected by surgery or ESD. Diagnosis, treatment methods and outcomes are evaluated. Results: In 49 cases of L-S ESCC, 32 cases were treated by ESD and 17 case were treated by surgery. Average size of tumor treated by ESD is 59.4 mm(50-85 mm). Accuracy of estimated depth of invasion by endoscopy for ESD cases is 65.7%. Four of 32 cases of ESD underwent additional therapy (3 for surgery and 1 for CRT) because of pT1b (SM2) or lymphvascular invasion, and one case has lymph-node metastasis. Rate of stricture after ESD is 20.0% for sub-circumference ESD and 77.8% for circumference ESD instead of steroid injection. Average time and duration for control of esophageal stricture by Balloon Bougie is 13.5 times and 18 weeks. Average size of tumor treated by surgery is 76.5 mm(50-130 mm). Accuracy of estimated depth of invasion by endoscopy for surgical cases is 47.1%. Seven cases in 17 (41.2%) have lymph node metastasis. One case died by recurrence after surgery and 48 cases were survived without any recurrences. Conclusions: Accuracy of estimated depth of invasion by endoscopy for L-S ESCC is cute low compared to normal superficial ESCC. Most of strictures after sub-circumference ESD could be prevented by steroid injection. However control of strictures after circumference ESD is difficult. Thus, diagnostic ESD should not be performed for circumferencial lesions of L-S ESCC for the patients who will select CRT for additional treatment, and CRT should be selected for first treatment of these cases. Long survival could be obtained by ESD or surgery for the patients of L-S ESCC by our treatment strategy.