Top

Published in:

01-04-2014

Outcomes of endoscopic resection for high-grade dysplasia and esophageal cancer

Authors: Steven J. Nurkin, Hector R. Nava, Sai Yendamuri, Charles M. LeVea, Chumy E. Nwogu, Adrienne Groman, Gregory Wilding, Andrew J. Bain, Steven N. Hochwald, Nikhil I. Khushalani

Published in: Surgical Endoscopy | Issue 4/2014

Abstract

Background

Endoscopic resection (ER) is an important advance in the management of esophageal tumors. It has been used successfully for superficial esophageal cancer and high-grade dysplasia (HGD) arising out of Barrett epithelium.

Methods

From a single institution within the Department of Surgery, patients who underwent ER for esophageal tumors between December 2001 and January 2012 were evaluated. Demographic, clinical, and pathologic variables were collected and reviewed.

Results

We identified 81 patients who underwent ER for esophageal lesions. Median patient age was 69 years, and the median follow-up was 3.25 years. In patients with HGD, at the time of last endoscopy, the complete eradication rate of HGD was 84 % and cancer-specific survival was 100 %. During surveillance, one patient developed an invasive carcinoma that required endoscopic therapy. Patients with T1a and negative deep margins on ER had a recurrence-free and cancer-specific survival of 100 %. There were seven patients with T1b and negative margins on ER. Three patients underwent esophagectomy; final pathology revealed no residual malignancy or lymph node metastasis. Two patients had definitive chemoradiation, and two patients were observed. To date, there has been no cancer recurrence. In all patients who underwent ER, there was one episode of bleeding that required endoscopic treatment and admission for observation.

Conclusions

ER can be performed safely and can adequately stage and often treat patients with HGD and superficial cancers. Patients with HGD and T1a disease with negative margins are cured with ER alone. Observation and surveillance may be an option for select patients with low-risk, early submucosal disease (T1b) and negative margins.

Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29PubMedCrossRef

Ajani JA, Barthel JS, Bentrem DJ, D’Amico TA, Das P, Denlinger CS, Fuchs CS, Gerdes H et al (2011) Esophageal and esophagogastric junction cancers. J Natl Compr Canc Netw 9(8):830–887

Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365(15):1375–1383PubMedCrossRef

Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshima H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39(1):58–62PubMedCrossRef

Peters JH, Watson TA (2011) Endoscopic mucosal resection of Barrett’s esophagus and early esophageal cancer. J Gastrointest Surg 15(8):1299–1302PubMedCrossRef

Nijhawan PK, Wang KK (2000) Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc 52(3):328–332PubMedCrossRef

Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T et al (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206PubMedCrossRef

Peters FP, Kara MA, Rosmolen WD, ten Kate FJ, Krishnadath KK, van Lanschot JJB et al (2006) Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol 101(7):1449–1457PubMedCrossRef

Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A et al (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65(1):3–10PubMedCrossRef

10.

Chennat J, Konda VJ, Ross AS, de Tejada AH, Noffsinger A, Hart J et al (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma—an American single-center experience. Am J Gastroenterol 104(11):2684–2692PubMedCrossRef

11.

Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C et al (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15(11):3278PubMedCrossRef

12.

Nigro JJ, Hagen JA, DeMeester TR, DeMeester SR, Peters JH, Oberg S et al (1999) Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 117(1):16–25PubMedCrossRef

13.

Sepesi B, Watson TJ, Zhou D, Polomsky M, Litle VR, Jones CE et al (2010) Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg 210(4):418PubMedCrossRef

14.

Dunbar KB, Spechler SJ (2012) 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 107(6):850–862PubMedCentralPubMedCrossRef

15.

Manner H, May A, Pech O, Gossner L, Rabenstein T, Günter E et al (2008) Early Barrett’s carcinoma with “low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol 103(10):2589–2597PubMedCrossRef

16.

Manner H, Pech O, Heldmann Y, May A, Pohl J, Behrens A et al (2013) Efficacy, safety, and long-term results of endoscopic treatment for early-stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 11(6):630–635PubMedCrossRef

Title: Outcomes of endoscopic resection for high-grade dysplasia and esophageal cancer
Authors: Steven J. Nurkin
Hector R. Nava
Sai Yendamuri
Charles M. LeVea
Chumy E. Nwogu
Adrienne Groman
Gregory Wilding
Andrew J. Bain
Steven N. Hochwald
Nikhil I. Khushalani
Publication date: 01-04-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3270-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes of endoscopic resection for high-grade dysplasia and esophageal cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2014

Laparoscopic liver resection and the learning curve: a 14-year, single-center experience

Nationwide outcomes of nontrauma splenectomy

Impact of fenestrations and surface profiling on the holding of tissue by parallel occlusion laparoscopic graspers

Objective analysis of surgeons’ ergonomy during laparoendoscopic single-site surgery through the use of surface electromyography and a motion capture data glove

Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy

Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay