Lymph node metastasis and treatment outcomes of endoscopic submucosal dissection for superficial spreading esophageal squamous cell carcinoma ≥ 50 mm in size.

Background: The precise indications for endoscopic submucosal dissection (ESD) in superficial spreading esophageal squamous cell carcinoma (SESCC) remain unclear. This study aimed to evaluate the lymph node metastasis rates and outcomes of ESD for SESCC lesions ≥ 50 mm, focusing on diagnostic accuracy, short-term outcomes, and long-term prognoses.

Methods: We retrospectively analyzed 79 patients who underwent ESD for SESCC between January 2011 and December 2018. We assessed lymph node metastasis rates, diagnostic accuracy, short-term outcomes, and long-term survival rates.

Results: The en bloc resection and R0 resection rates were 98.7% and 94.9%, respectively. The diagnostic accuracy for tumor invasion depth was 74.7%. Lymph node metastasis occurred in 7.6% of patients, contributing to four primary cancer-related deaths (3.8%). Postoperative esophageal stenosis occurred in 65.6% of whole-circumference cases, with refractory stenosis requiring > 5 endoscopic balloon dilation procedures in 87.5% of affected patients. Overall survival (OS) rates were 91% at 3 years and 84% at 5 years, whereas recurrence-free survival (RFS) rates were 87% at 3 years and 80% at 5 years.

Conclusions: ESD for SESCC achieves high resection success rates but is associated with significant challenges, including refractory stenosis and lymph node recurrence, particularly in pLPM and pMM cases. Enhanced diagnostic and surveillance protocols, along with novel strategies for stenosis prevention, are necessary to improve outcomes and patient quality of life. Further comparative studies with surgical and chemoradiotherapy modalities are also needed.