The aim of this study is to investigate the related factors indicating necessarily second esophagectomy after the treatment of endoscopic resection (ER) in early stage of esophageal cancer.

From June 2011 to March 2014, the data of patients with early stage esophageal cancer treated with ER were prospectively collected from the Department of Thoracic Surgery of Shanghai Cancer Hospital. Patients with or without further esophagectomy were followed up, and statistical analysis was carried out based on the factors including the depth of invasion(T grade), the depth of invasion of ER lesion(T0-1a or beyond T1a), the length of lesion(<3cm or ≥3cm), the location of tumor(upper, middle or lower), the degree of differentiation, and with or without lymph vascular invasion among patients without tumor residual after esophagectomy.

Eighty-eight patients with early stage esophageal cancer indicated by preoperative examination and staging underwent ER surgery, and 22(25.0%) of them received further esophagectomy, among whom 7(31.8%) had no tumor residual according to the final pathological reports. Statistical analysis showed that the invasive depth of ER lesion (T0-1a or above T1b) was a predicting factor which could indicate whether the patient need further radical surgery or not(χ²=8.56, P=0.005), while that had no significant effect on the length of lesion, location of lesion, differentiation degree and lymphatic vessel invasion(χ²=1.89, P=0.361; χ²=3.01, P=0.165; χ²=3.85, P=0.121; χ²=1.02, P=1.000).

Patients with lesions at stage T0-1a and negative surgical margin based on the pathological results can probably avoid esophagectomy after ER. While those beyond T1a stage, especially those with dissatisfaction about ESD mucosal protrusion after submucous injection with Methylene blue or endoscopic mucosal resection(EMR) mucosal trap, were recommended for esophagectomy. As for early stage cardia cancer, it should be very cautious when choosing to perform ER surgery.