A novel esophagus-preserving strategy for T1b esophageal cancer combining endoscopic submucosal dissection and thoracoscopic lymph nodes sampling: the first case series.

Background: Esophageal squamous cell carcinoma (ESCC) is highly prevalent in Asia. The management of T1b ESCC is challenging due to two competing concerns: the relatively low but prognostically significant risk of lymph node metastasis (LNM), and the considerable postoperative morbidity associated with radical esophagectomy. Based on the retrospective data and relevant studies, we pioneered a novel "dual-scopy combined surgery", as combining endoscopic submucosal dissection with the thoracoscopic lymph node sampling (ESD + TLNS) approach to achieve precise staging and esophagus preservation. Methods: In this prospective study, eligible T1b ESCC patients underwent the "dual-scopy combined surgery". We analyzed the baseline characteristics of nine participants and compared their perioperative and mid-to-long-term outcomes with those of patients undergoing radical esophagectomy. Results: Nine patients underwent the combined procedure. The mean number of lymph nodes sampled was 10.22±4.82, and all were negative on frozen section. Compared to a matched radical esophagectomy cohort (n=9), the ESD + TLNS group exhibited superior perioperative outcomes, including significantly shorter operative duration (135.38±48.00 Conclusions: The "dual-scopy combined surgery" is safe and effective and lies in the realization of a transformation in the treatment paradigm. It represents a significant attempt to preserve the esophagus in the treatment of T1b esophageal cancer. This paradigm warrants validation in larger comparative studies.