Yang YM, Dai T, Zou LY, Zhao CJ. Analysis of risk factors for disease recurrence after endoscopic submucosal dissection of early esophageal cancer. World J Gastrointest Surg 2025; 17(12): 111714 [DOI: 10.4240/wjgs.v17.i12.111714]
Corresponding Author of This Article
Cheng-Jin Zhao, MD, Doctor, Department of Gastroenterology, Nantong First People’s Hospital, Southeast University Affiliated Nantong First People’s Hospital, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. jackiel1980@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Yang YM, Dai T, Zou LY, Zhao CJ. Analysis of risk factors for disease recurrence after endoscopic submucosal dissection of early esophageal cancer. World J Gastrointest Surg 2025; 17(12): 111714 [DOI: 10.4240/wjgs.v17.i12.111714]
Yan-Mei Yang, Ting Dai, Ling-Yu Zou, Cheng-Jin Zhao, Department of Gastroenterology, Nantong First People’s Hospital, Southeast University Affiliated Nantong First People’s Hospital, Nantong 226001, Jiangsu Province, China
Co-first authors: Yan-Mei Yang and Ting Dai.
Author contributions: Yang YM, Dai T contributed to conceptualization, data curation, methodology, software, writing original draft; Zou LY contributed to formal analysis, project administration, visualization; Zhao CJ contributed to investigation, supervision, validation, writing, review and editing.
Institutional review board statement: The study was reviewed and approved by Nantong First People’s Hospital, Southeast University Affiliated Nantong First People’s Hospital (No. 2025KT177).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Jackiel1980@163.com. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Jin Zhao, MD, Doctor, Department of Gastroenterology, Nantong First People’s Hospital, Southeast University Affiliated Nantong First People’s Hospital, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. jackiel1980@163.com
Received: August 1, 2025 Revised: August 23, 2025 Accepted: October 20, 2025 Published online: December 27, 2025 Processing time: 145 Days and 18.2 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is a minimally invasive, safe, and efficient treatment technique for patients diagnosed with early esophageal cancer. However, postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life. As such, identification of relevant risk factors for recurrence can help optimize postoperative management strategies.
AIM
To assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.
METHODS
Clinical data from 210 patients diagnosed with early stage esophageal cancer, who underwent ESD at the authors’ center between March 2012 and March 2025, were retrospectively collected and analyzed. Patients were categorized into 2 groups according to postoperative disease recurrence: Recurrence (n = 30), and without recurrence (n = 180). Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period. Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.
RESULTS
During the follow-up period, 30 patients experienced tumor recurrence, corresponding to a recurrence rate of 14.19%. Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence [odds ratio (OR) = 1.782, 95% confidence interval (CI): 1.154-2.196; P < 0.001]. Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa (OR = 1.573, 95%CI: 1.073-2.481; P < 0.001). Furthermore, inability to completely resect the tumor greatly increased the likelihood of recurrence (OR = 2.189, 95%CI: 1.193-3.125; P = 0.001). Tumor diameter ≥ 2 cm was an independent risk factor for postoperative recurrence (OR = 1.981, 95%CI: 1.482-2.862; P = 0.005).
CONCLUSION
Recurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation, depth of lesion invasion, complete resection status of the tumor, and tumor diameter.
Core Tip: The disease recurrence rate after endoscopic submucosal dissection for early esophageal cancer was 14.19%. A low degree of differentiation, infiltration into the submucosa, incomplete tumor resection, and tumor diameter ≥ 2 cm were independent risk factors for postoperative recurrence. Accurate assessment of these risk factors can help inform personalized follow-up strategies and secondary treatment plans to increase patients’ chances of long-term survival.
