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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2016

01-08-2016 | Thoracic Oncology

Outcomes of Surgical Resection of T1bN0 Esophageal Cancer and Assessment of Endoscopic Mucosal Resection for Identifying Low-Risk Cancers Appropriate for Endoscopic Therapy

Authors: Kamran Mohiuddin, MD, Russell Dorer, MD, Mustapha A. El Lakis, MD, Hejin Hahn, MD, PhD, James Speicher, MD, Michal Hubka, MD, Donald E. Low, MD, FACS, FRCS

Published in: Annals of Surgical Oncology | Issue 8/2016

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Abstract

Background

Invasive esophageal cancers have been managed historically with esophagectomy. Low-risk T1b patients are being proposed for nonsurgical management. The purpose of this study was to evaluate the ability of endoscopic mucosal resections (EMR) to identify low-risk T1b patients and to review surgical treatment outcomes for T1b cancer.

Methods

All esophageal cancer patients, in an institutional review board-approved prospective database, between 2000 and 2013 with clinical stage (cT1bN0), pathological stage (pT1bN0), and no neoadjuvant therapy were retrospectively reviewed.

Results

Fifty-one patients, 38 pT1b and 13 cT1b, were assessed. All cT1b had preoperative EMR and five were found to be understaged at esophagectomy. pT1bN0 patients had a mean age of 66 years, mean BMI of 30, and 95 % had adenocarcinoma. Thirty-eight pT1bN0 patients underwent esophagectomy with a median hospital length of stay (LOS) of 9 days. Complications occurred in 14 patients, but 71 % were minor (Accordion score 1–2). In-hospital 30- and 90-day mortality was zero. EMR specimens were re-reviewed to assess low-risk criteria. Degree of differentiation and the presence of lymphovascular invasion could be assessed in all EMR specimens; however, assessment of submucosal invasion limited to the superficial submucosal layer could not be determined in the majority of cases. Kaplan–Meier 5-year overall survival in pT1bN0 patients was 78.7 %.

Conclusions

Clinical staging of superficial esophageal cancer can be inaccurate especially in submucosal tumors. EMR should be routinely used for preoperative staging. Healthy patients with clinical tumor stage greater than cT1a should undergo multidisciplinary review and be considered for surgical resection.
Literature
1.
2.
Stein HJ, Feith M, Bruecher BL, et al. Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg. 2005;242:566–73, discussion 73–5.PubMedPubMedCentral
3.
Pech O, Bollschweiler E, Manner H, et al. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg. 2011;254:67–72.CrossRefPubMed
4.
Phoa KN, Pouw RE, Bisschops R, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2015. doi:10.​1136/​gutjnl-2015-309298.
5.
Lyday WD, Corbett FS, Kuperman DA, et al. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy 2010;42:272–8.CrossRefPubMed
6.
Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.CrossRefPubMed
7.
Sepesi B, Watson TJ, Zhou D, et al. Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg. 2010;210:418–27.CrossRefPubMed
8.
Sgourakis G, Gockel I, Lyros O, et al. Detection of lymph node metastases in esophageal cancer. Expert Rev Anticancer Ther. 2011;11:601-12.CrossRefPubMed
9.
10.
Manner H, Pech O, Heldmann Y, et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol. 2013;11:630–5. quiz e45.CrossRefPubMed
11.
Pech O, May A, Manner H, Behrens A, et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology. 2014;146:652–60 e1.CrossRefPubMed
12.
Lorenz D, Origer J, Pauthner M, et al. Prognostic risk factors of early esophageal adenocarcinomas. Ann Surg. 2014;259:469–76.CrossRefPubMed
13.
Kaneshiro DK, Post JC, Rybicki L, et al. Clinical significance of the duplicated muscularis mucosae in Barrett esophagus-related superficial adenocarcinoma. Am J Surg Pathol. 2011;35:697–700.CrossRefPubMed
14.
Akutsu Y, Uesato M, Shuto K, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg. 2013;257:1032–8.CrossRefPubMed
15.
Eguchi T, Nakanishi Y, Shimoda T, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006;19:475–80.CrossRefPubMed
16.
Prasad GA, Wu TT, Wigle DA, et al. Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 2009;137:815–23.CrossRefPubMed
17.
Schembre DB. Endotherapy for Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma. J Gastrointest Surg. 2009;13:1172–8.CrossRefPubMed
18.
Pech O. Endoscopic therapy of high-grade dysplasia and intramucosal adenocarcinoma: 2 small steps for the endoscopists but a fine step forward for the patient. Gastrointest Endosc. 2015;81:1167–9.CrossRefPubMed
19.
Small AJ, Sutherland SE, Hightower JS, et al. Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett’s esophagus. Gastrointest Endosc. 2015;81:1158–66 e1-4.CrossRefPubMed
20.
Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007;65:3–10.CrossRefPubMed
21.
Sangle NA, Taylor SL, Emond MJ, et al. Overdiagnosis of high-grade dysplasia in Barrett’s esophagus: a multicenter, international study. Mod Pathol. 2015;28:758–65.CrossRefPubMed
22.
Lewis JT, Wang KK, Abraham SC. Muscularis mucosae duplication and the musculo-fibrous anomaly in endoscopic mucosal resections for barrett esophagus: implications for staging of adenocarcinoma. Am J Surg Pathol. 2008;32:566–71.CrossRefPubMed
23.
Mandal RV, Forcione DG, Brugge WR, et al. Effect of tumor characteristics and duplication of the muscularis mucosae on the endoscopic staging of superficial Barrett esophagus-related neoplasia. Am J Surg Pathol. 2009;33:620–5.CrossRefPubMed
24.
Abraham SC, Krasinskas AM, Correa AM, et al. Duplication of the muscularis mucosae in Barrett esophagus: an underrecognized feature and its implication for staging of adenocarcinoma. Am J Surg Pathol. 2007;31:1719–25.CrossRefPubMed
25.
Estrella JS, Hofstetter WL, Correa AM, et al. Duplicated muscularis mucosae invasion has similar risk of lymph node metastasis and recurrence-free survival as intramucosal esophageal adenocarcinoma. Am J Surg Pathol. 2011;35:1045–53.CrossRefPubMed
26.
Alvarez Herrero L, Pouw RE, van Vilsteren FG, et al. Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens. Endoscopy 2010;42:1030–6.CrossRefPubMed
27.
Leers JM, DeMeester SR, Oezcelik A, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg. 2011;253:271–8.CrossRefPubMed
28.
Ancona E, Rampado S, Cassaro M, et al. Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol. 2008;15:3278–88.CrossRefPubMed
29.
Nentwich MF, von Loga K, Reeh M, et al. Depth of submucosal tumor infiltration and its relevance in lymphatic metastasis formation for T1b squamous cell and adenocarcinomas of the esophagus. J Gastrointest Surg. 2014;18:242–9. discussion 9.CrossRefPubMed
30.
Dubecz A, Kern M, Solymosi N, Schweigert M, Stein HJ. Predictors of lymph node metastasis in surgically resected T1 esophageal cancer. Ann Thorac Surg. 2015;99:1879–85. discussion 86.CrossRefPubMed
31.
Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2012;107:850–62. quiz 63.CrossRefPubMedPubMedCentral
32.
Bennett C, Green S, Decaestecker J, et al. Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett’s oesophagus. Cochrane Database Syst Rev. 2012. doi: 10.​1002/​14651858.​CD007334.​pub4.
33.
Markar SR, Schmidt H, Kunz S, et al. Evolution of standardized clinical pathways: refining multidisciplinary care and process to improve outcomes of the surgical treatment of esophageal cancer. J Gastrointest Surg. 2014;18:1238–46.CrossRefPubMed
34.
Worrell SG, Boys JA, Chandrasoma P et al. Interobserver variability in the interpretation of endoscopic mucosal resection specimens of esophageal adenocarcinoma: interpretation of ER specimens. J Gastrointest Surg. 2016;20:140–5.CrossRefPubMed
Metadata
Title
Outcomes of Surgical Resection of T1bN0 Esophageal Cancer and Assessment of Endoscopic Mucosal Resection for Identifying Low-Risk Cancers Appropriate for Endoscopic Therapy
Authors
Kamran Mohiuddin, MD
Russell Dorer, MD
Mustapha A. El Lakis, MD
Hejin Hahn, MD, PhD
James Speicher, MD
Michal Hubka, MD
Donald E. Low, MD, FACS, FRCS
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5138-y

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