Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Esophageal squamous cell carcinoma (ESCC) is an aggressive malignancy with poor prognosis in Asian countries (1). The clinical-surgical-pathological T/N/M-status and cancer stage defined in the American Joint Committee on Cancer (AJCC) manual remained the cornerstone to predict survivals and tailor optimal treatment modalities for ESCC patients (2,3). Concerning the definition of T-status, the emphasis on tumor length (T1 or clinical stage I: tumor length ≤5 cm; T2 or clinical stage II: tumor length >5 cm length; T3 or clinical stage III: evidence of extra-esophageal spread; AJCC manual, 2nd edition, 1983) had been shifted to the depth of tumor invasion since 1988 (AJCC manual, 3–7th editions, 1988–2010) (4). Recently, the roles of tumor length in ESCC have been reappraised and some showed clinically relevance in the prediction of surgical resectability, survival outcomes, or acting as a criterion to select proper cases for neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgical resection (5-13)