Therapeutic Outcomes of Endoscopic Submucosal Dissection for Superficial Squamous Cell Carcinoma in the Remnant Esophagus After Subtotal Esophagectomy

Background and Aim Limited reports exist on the treatment outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy. Therefore, we aimed to investigate the feasibility and efficacy of endoscopic submucosal dissection in such cases. Methods We identified consecutive patients who underwent endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy between January 2010 and June 2024 from a prospectively maintained database and retrospectively evaluated the short‐ and long‐term outcomes. Results A total of 43 consecutive patients with 49 lesions were included in this study. All lesions, including 15 involving the anastomotic site, were resected en bloc with tumor‐free vertical margins. The median resection time was 40 min. No perforations, delayed bleeding, or aspiration pneumonia were observed. The median lesion size was 15 mm with most being intramucosal cancer (97%, 48/49). Post‐ESD stricture occurred in three patients (6%). In univariate analysis, larger lesion size and greater circumferential extent were significantly associated with longer resection time (≥ 90 min). Lesions involving the anastomotic site were not significantly associated with longer resection times. No local recurrence was observed during a median follow‐up period of 3 years. The 3‐year overall survival and disease‐specific survival rates were 89% and 100%, respectively. Conclusions Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy is technically feasible and effective, with favorable long‐term outcomes. It might present a reasonable treatment option for such cases.