• Yin-Kai Chao, Wen-Yu Chuang, Chi-Ju Yeh, Hsien-Kun Chang, and Chen-Kan Tseng.
• Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
• Eur J Cardiothorac Surg. 2018 Jan 1; 53 (1): 201-208.

ObjectivesRecent advances in neoadjuvant chemoradiotherapy (nCRT) have significantly increased the rates of pathological complete response achieved by patients with oesophageal cancer. Consequently, a watchful waiting strategy based on 'active endoscopic surveillance and surgery as needed' has been proposed for cases without clinical evidence of disease after neoadjuvant chemoradiotherapy. Here, we investigated whether endoscopic surveillance is a reliable tool for the detection of the initially unidentified residual cancer in this patient group.MethodsWe performed a careful pathological re-review of all cases with oesophageal squamous cell carcinoma, who attained a clinical complete response, despite showing a pathological non-complete response. The detailed anatomical locations of such unidentified malignancies were investigated in each patient to determine the prevalence of cancer involvement for each oesophageal layer.ResultsAmong the 73 patients with clinical complete response, 46 (63%) patients were found to have pathological non-complete response. The majority (89.1%; n = 41) of patients had evidence of residual cancer in the oesophagus, whereas only 5 (10.9%) patients had T0N+ disease. However, a high percentage (39.1%; n = 16) of patients had no detectable cancer in the mucosa and 9 of them also had no detectable cancer in sub-mucosal layer, ultimately hampering their detection via endoscopic biopsy.ConclusionsNearly 40% of patients with oesophageal squamous cell carcinoma who attained clinical complete response but showed a pathological non-complete response had residual cancer hidden underneath a cancer-free mucosa layer.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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