Naito S, Yoshio T, Ishiyama A, et al. - In this analysis of long-term outcomes of endoscopic resection (ER) in patients with pathological (p) invasion of esophageal squamous cell carcinoma (ESCC) into the T1a-muscularis mucosae (MM) and T1b-submucosa (SM), findings showed favorable outcomes were achieved with ER preceding appropriate additional treatments.

• Of 1217 patients with superficial ESCC who had ER, 225 with a pathological diagnosis of ESCC invasion into the MM, minute submucosal invasion ≤200 µm (SM1), or massive submucosal invasion (SM2) were analyzed in this study.

• Metastatic recurrence occurred in 1.3%, 10.7%, and 6.5% cases with pT1a-MM, pT1b-SM1, and pT1b-SM2 ESCCs, respectively.

• In patients with pT1a-MM, pT1b-SM1, and pT1b-SM2 ESCCs, 5-year overall survival rates were reported to be 84.1%, 71.4%, and 67.4% and 5-year relapse-free survival rates were 82.8%, 64.3%, and 65.2%, respectively.

• The 5-year disease-specific survival rates were 100%, 96.4%, and 99.1% in pT1a-MM, pT1b-SM1, and pT1b-SM2 ESCCs, respectively.

• In this cohort, many patients with metastatic recurrence could be successfully treated.

• Additional chemoradiation and esophagectomy, and T1b-SM2 showed positive and negative links with overall survival, respectively.