Clinical characteristics of synchronous and metachronous superficial esophageal squamous cell carcinoma during surveillance after endoscopic submucosal dissection

Q: What was the main aim of this study?

To compare clinicopathologic characteristics and outcomes between initial SESCC lesions and secondary (synchronous and metachronous) SESCC lesions detected during follow-up after ESD.

Q: How were lesions classified in the analysis?

Lesions were categorized as initial or secondary based on the timing when the lesions were detected during surveillance.

Q: What were the key differences between secondary and initial lesions?

Secondary lesions tended to be smaller and shallower, which corresponded to higher curative resection rates and fewer complications compared with initial lesions.

Sep 22, 2026

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Background: Endoscopic submucosal dissection (ESD) is standard for superficial esophageal squamous cell carcinoma (SESCC), yet the clinical characteristics of synchronous and metachronous lesions found during follow-up are unclear. This study compares clinicopathologic features and outcomes of initial versus secondary SESCC lesions. Methods: A single-center analysis of 307 ESCC lesions from 188 patients treated with ESD between 2005 and 2025. Results: Secondary lesions were younger-associated, smaller (<20 mm), shallower, and showed higher curative resection with fewer complications. Independent associations included smaller size and superficial invasion depth. Conclusion: Secondary lesions are more amenable to curative ESD when detected early through regular post-ESD surveillance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Materials and methods

Study design and patients

Endoscopic resection

Surgical Endoscopy (2026) 40:4875–4882 [https://doi.org/10.1007/s00464-026-12816-3](https://doi.org/10.1007/s00464-026-12816-3) and Other Interventional Techniques Clinical characteristics of synchronous and metachronous superficial esophageal squamous cell carcinoma during surveillance after endoscopic submucosal dissection Marina Kuroda1 · Yohei Ikenoyama1 · Hiroto Suzuki1 · Aiji Hattori1 · Misaki Nakamura1 · Yasuhiko Hamada1 · Noriyuki Horiki2 · Hayato Nakagawa1 Received: 9 January 2026 / Accepted: 3 April 2026 / Published online: 20 April 2026 © The Author(s) 2026 Abstract Background Although endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), the clinical characteristics of synchronous and metachronous (secondary) lesions detected during follow-up remain unclear. This study aimed to compare the clinicopathologic characteristics and outcomes of initial and secondary SESCC lesions. Methods This single-center study analyzed 307 esophageal squamous cell carcinoma lesions in 188 patients who underwent ESD as their initial treatment between January 2005 and January 2025. The lesions were categorized as initial (n = 208) or secondary (n = 99) based on their timing of detection. Clinicopathological features and short-term outcomes were compared between the two groups. Results Patients with multiple lesions were younger and had a higher prevalence of prior head and neck cancer and a higher prevalence ofLugol-voiding lesion grades B/C. The median time to detection of secondary lesions was 18 months. Secondary lesions were smaller (< 20 mm: 88% vs. 44%) and shallower (epithelial/lamina propria mucosa: 89% vs. 74%) than initial lesions. Multivariate analysis revealed that tumor size < 20 mm (odds ratio 0.12, 95% confidence interval 0.06–0.23) and epithelial/lamina propria mucosa invasion depth (odds ratio 0.37, 95% confidence interval 0.17–0.84) were independently associated with secondary lesions. In secondary lesions, curative resection rates were higher (84% vs. 68%, p < 0.005) and complications less frequent (12% vs. 34%, p < 0.001) . Esophageal stenosis occurred less frequently in secondary lesions. The cumulative incidences of secondary lesions were 10.2%, 18.9%, and 28.2% at 1, 3, and 5 years, respectively. Conclusion Secondary SESCC lesions tend to be smaller and shallower, enabling higher curative resection rates and lower complication risks. These findings suggest that secondary lesions are more amenable to curative ESD when detected at an early stage. Regular surveillance after ESD facilitates early detection of secondary lesions and their curative resection. Keywords Esophageal squamous cell carcinoma · Endoscopic submucosal dissection · Metachronous neoplasms · Clinicopathologic characteristics Esophageal cancer ranks as the eighth most prevalent cancer worldwide and the sixth leading cause of cancer-related mortality [1]. Esophageal squamous cell carcinoma (ESCC) * Yohei Ikenoyama [0801yohei@med.mie-u.ac.jp](0801yohei@med.mie-u.ac.jp) 1 Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan 2 Department of Endoscopy, Mie University Graduate School of Medicine, Tsu, Japan remains the predominant histologic type, particularly in Southern and Eastern Africa and Central Asia, where it accounts for most cases [2, 3] . In Japan, 80–90% of esophageal cancers are ESCC, and both incidence and mortality have increased with the aging population [4] . Early detection is crucial for achieving favorable treatment outcomes, as ESCC can progress rapidly and requires surgical intervention once it invades the submucosal layer. Therefore, early diagnosis leading to indications for endoscopic submucosal dissection (ESD) and treatment with ESD is important [5, 6] . The optimal post-ESD management strategy has not been fully established a

FAQs

What was the main aim of this study?

To compare clinicopathologic characteristics and outcomes between initial SESCC lesions and secondary (synchronous and metachronous) SESCC lesions detected during follow-up after ESD.

How were lesions classified in the analysis?

Lesions were categorized as initial or secondary based on the timing when the lesions were detected during surveillance.

What were the key differences between secondary and initial lesions?

Secondary lesions tended to be smaller and shallower, which corresponded to higher curative resection rates and fewer complications compared with initial lesions.

Sep 22, 2026

Upload by Miles