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Ishihara. Mini-invasive Surg 2021;5:36 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.72

Review Open Access

Indications of esophageal cancer for endoscopic

submucosal dissection, curability, and future
perspectives

Ryu Ishihara

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Correspondence to: Dr. Ryu Ishihara, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69
Otemae, Chuo-ku, Osaka 541-8567, Japan. E-mail: ryu1486@gmail.com
How to cite this article: Ishihara R. Indications of esophageal cancer for endoscopic submucosal dissection, curability, and future
perspectives. Mini-invasive Surg 2021;5:36. https://dx.doi.org/10.20517/2574-1225.2021.72
Received: 1 Jun 2021 First Decision: 21 Jun 2021 Revised: 27 Jun 2021 Accepted: 7 Jul 2021 First online: 8 Jul 2021

Academic Editor: Shinji Tanaka Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
This review considers the preferred preoperative examinations, indications for endoscopic submucosal dissection
(ESD), and curative ability of ESD in patients with esophageal squamous cell carcinoma (SCC). Endoscopic
evaluation by non-magnifying endoscopy followed by magnifying endoscopy is a common procedure for diagnosing
invasion depth of superficial esophageal SCCs in Japan. However, endoscopic ultrasonography may increase
overdiagnosis of the depth of cancer invasion, and therefore should not be performed routinely. Image-enhanced
magnifying endoscopy or iodine staining is recommended for diagnosing the lateral extent of esophageal SCC. The
indications for ESD include clinical T1a-epithelial/lamina propria (EP/LPM) N0M0 non-circumferential lesions,
clinical T1a EP/LPM N0M0 circumferential lesions ≤ 50 mm, and clinical T1a-muscularis mucosae/T1b-submucosa
1 cancer (invading submucosa by ≤ 200 µm) N0M0 non-circumferential lesions. Pathological T1a EP/LPM without
vascular invasion is defined as curative resection, while pathological T1a MM without vascular invasion is
considered as non-curative resection, with undetermined recommendations for additional treatment. Pathological
T1b cancer invading the submucosa or pathological vascular invasion-positivity is considered as non-curative
resection, and additional treatment is recommended. An accurate preoperative diagnosis, appropriate indication,
and adequate curability assessment based on the pathological diagnosis of resected specimens are important for
effective ESD.

Keywords: Esophageal cancer, cancer invasion depth, endoscopic submucosal dissection

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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