S2267 Long-Term Outcomes of Patients With T1b Esophageal Carcinoma Status Post Endoscopic Resection With Esophagectomy or Surveillance

Introduction: Esophagectomy is considered standard of care for patients with T1b esophageal carcinoma (EC) with high-risk features due to increased risk for lymph node metastasis (LNM). However, endoscopic resection (ER) can be curative in cases of superficial submucosal invasion. We aimed to compare the disease-free survival and overall survival in patients with T1b EC status post ER and esophagectomy or active surveillance. Methods: Patients with EC at our tertiary care academic medical center treated with ER [endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)] from January 2012-December 2021 with ER specimen staged as pathologic T1bNX EC with no presumed metastasis after ER and with at least 1 year of follow-up since ER were included. Histopathologic high-risk features were recorded, and disease-free survival and overall survival was assessed. Independent-samples t-test, Fisher’s exact test and the Kaplan-Meier method were used for statistical analysis. Results: Forty-one cases with pT1b EC were included (N = 19 ER with surveillance, N = 22 ER with esophagectomy), and most cases were adenocarcinoma (N = 39). The mean age was 73 ± 11 years (ER with surveillance) and 68 ± 7 years (ER with esophagectomy) (P = 0.81), and the Charlson co-morbidity index was 6.6 ± 3.8 (ER with surveillance) and 4.6 ± 2.5 (ER with esophagectomy) (P = 0.06). Tumor size was 1.23 ± .67 cm and 2.24 ± 2.14 in the surveillance and esophagectomy groups (P = 0.06). ESD was the main ER performed. Most lesions were in the lower third of the esophagus and/or GEJ. High-risk features were comparable in the 2 groups, however, patients in the esophagectomy group were more likely to have positive ER margins (13/23) (P < 0.001). Five patients in the esophagectomy group received neo and/or adjuvant chemotherapy and 1 patient had radiation prior to esophagectomy. Ten (42%) patients with esophagectomy had residual disease on surgical pathology and 4 (17%) had LNM. Additionally, recurrence occurred in 3 (16%) and 6 (25%) patients in the surveillance and esophagectomy groups. There was no difference in disease-free survival (0.433) or overall survival (P = 0.610). Two patients died from post-surgical complications. Conclusion: Patients T1b EC with positive margins were likely to undergo esophagectomy, as expected. Outcomes did not differ for patients who underwent ER with esophagectomy compared to ER with active surveillance.