S928 Outcomes After Endoscopic Resection for Esophageal Adenocarcinoma: Insights into Curative Potential and Prognostic Indicators

Introduction: Endoscopic resections (ER) with curative intent are routinely performed on newly diagnosed esophageal adenocarcinomas (EAC). Few studies exist correlating pathological features in ERs and clinical outcomes. This retrospective study examines the significance of standard clinical and ER pathologic features from a single tertiary-care institution and their association with patient outcome. Methods: A retrospective study of EAC patients who underwent endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) from 2004-2023 was performed. Pathologic features of ER specimens were assessed along with clinical outcomes. Outcomes assessed included local/regional recurrence, follow-up ER or esophagectomy, and disease-specific mortality. Follow-up was recorded in months and correlated with pathology findings. Results: Fifty-seven ER patients were identified. Fifty-three patients underwent EMR, 4 ESD. Median follow-up was 53 months [range 3-1002]. Thirty-four patients underwent 1 ER, 5 underwent follow-up ER after primary resection. Eighteen patients underwent follow-up esophagectomy—14 patients had no evidence of recurrence with a median follow-up of 66 months (range 16-195), and 1 patient developed evidence of distant metastases. Pathologic features: 2 of 9 Grade 3 EACs; 4 of 5 with lymphovascular invasion (LVI), 14 of 30 with deep margin positive, 13 of 23 with mucosal margin positive had poor outcomes. Only 6 of 26 fragmented specimens were associated with poor outcomes. Conclusion: Our findings support the curative potential of endoscopic resection for the majority patients with superficial EAC. Though recurrence rates are low in these preselected patients, pathological assessments of tumor grade, LVI, and margin status, especially deep margin, emerged as important predictors of recurrence. Consideration of EAC endoscopic resection pathological findings is central to ongoing surveillance of these high-risk patients.