Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study

Post-endoscopic resection (ER) management of high risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastasis (LNM). We aimed to assess outcomes following radical ER for high risk T1 EAC.We identified patients who underwent radical ER (tumor-negative deep margin) of high risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008 and 2019 across 11 international centers.106 patients (86 men; mean [SD] age, 70 [11] years) were included. Of these, 26 (age, 64 [11] years) underwent additional surgery, with residual T1 EAC found in five patients (19%) and LNM in two (8%). After a median [IQR] follow-up of 47 [32-79] months, 2/26 patients (8%) developed LNM/distant metastasis, with one EAC-related death (4%), one unrelated death (4%), and four patients lost to follow-up (15%). Of the 80 patients (age, 71 [9] years) who entered endoscopic surveillance, 5/80 (6%) developed LNM/distant metastasis, with four EAC-related deaths (5%) over 46 (IQR 25-59) months follow-up; there were 15 unrelated deaths (19%), and 10 patients lost to follow-up (13%). The overall rates (95%CI) were: LNM, 6% (2%-12%); LNM/distant metastasis, 7% (3%-13%); EAC-related mortality, 5% (2%-11%); overall mortality, 20% (95%CI 13-29).Our findings present low rates of LNM after radical ER of high risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.

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Journal
Endoscopy
Published
2025-02-13
DOI
https://doi.org/10.1055/a-2538-9316
Citations
4
Primary Topic
Esophageal Cancer Research and Treatment
Type
article
Field-Weighted Citation Impact
8.03

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article

Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study

Pradeep Mundre, Maximilien Barret, Emmanuel Coron, Stefan Seewald et al.
4 citations
Endoscopy
Esophageal Cancer Research and Treatment
8.03
article

Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study

Pradeep Mundre, Maximilien Barret, Emmanuel Coron, Stefan Seewald, Roos E. Pouw, Sybren L. Meijer, Sunil Gupta, Andreas V. Hadjinicolaou, Philippe Leclercq, Rehan Haidry, Jacques J.G.H.M. Bergman, Philippe Nafteux, C Vuckovic, Arnaud Lemmers, Man Wai Chan, Paul Doumbe-Mandengue, Benjamin Norton, Massimiliano di Pietro, Raf Bisschops, Michael J. Bourke, Oliver Pech
article en
4 citations

Abstract

Post-endoscopic resection (ER) management of high risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastasis (LNM). We aimed to assess outcomes following radical ER for high risk T1 EAC.We identified patients who underwent radical ER (tumor-negative deep margin) of high risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008 and 2019 across 11 international centers.106 patients (86 men; mean [SD] age, 70 [11] years) were included. Of these, 26 (age, 64 [11] years) underwent additional surgery, with residual T1 EAC found in five patients (19%) and LNM in two (8%). After a median [IQR] follow-up of 47 [32-79] months, 2/26 patients (8%) developed LNM/distant metastasis, with one EAC-related death (4%), one unrelated death (4%), and four patients lost to follow-up (15%). Of the 80 patients (age, 71 [9] years) who entered endoscopic surveillance, 5/80 (6%) developed LNM/distant metastasis, with four EAC-related deaths (5%) over 46 (IQR 25-59) months follow-up; there were 15 unrelated deaths (19%), and 10 patients lost to follow-up (13%). The overall rates (95%CI) were: LNM, 6% (2%-12%); LNM/distant metastasis, 7% (3%-13%); EAC-related mortality, 5% (2%-11%); overall mortality, 20% (95%CI 13-29).Our findings present low rates of LNM after radical ER of high risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.

EndoscopyVol. 57(07)
The University of Sydney (AU), University of Cambridge (GB), Dutch Cancer Society (NL), Erasmus Hospital (BE), Cambridge University Hospitals NHS Foundation Trust (GB), Westmead Hospital (AU), Centre Hospitalier Universitaire de Nantes (FR), Centre Hospitalier Chrétien (BE), Cancer Research UK Cambridge Center (GB), Hôpital Cochin (FR), Klinik Hirslanden (CH), Clinique Saint-Joseph (BE), Westmead Institute (AU), Cleveland Clinic London (GB), Amsterdam University Medical Centers (NL), Bradford Teaching Hospitals NHS Foundation Trust (GB), University College London (GB), University of Amsterdam (NL), Nantes Université (FR), KU Leuven (BE)
Boston Scientific Corporation, Cook Medical, Fonds Wetenschappelijk Onderzoek, Vlaamse regering
Good health and well-being
Openalex Percentile: Top 3%
Esophageal Cancer Research and Treatment
8.03
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