188 High Risk of Systemic Disease with Clinically Predicted T1 Oesophageal Adenocarcinomas Undergoing Surgery

Abstract Aim This study aimed to analyse the demographic, pathological and survival outcomes of patients with clinically predicted T1 oesophageal adenocarcinoma who underwent surgery in a high-volume national centre. Method Patients with clinically predicted T1 oesophageal adenocarcinoma who underwent surgery between 2010-2024 were identified from a prospectively defined dataset, excluding those who received neoadjuvant therapy. A total of 149 patients were included. Demographics, indications for surgery (after staging EMR or straight to surgery), staging investigations (EUS, PET-CT, Paris classification), surgical details, post-operative complications (Clavien-Dindo Classification), rate of nodal metastasis, survival and recurrence rates were analysed. Results 149 patients had surgery with mean age of 64.41 years and 79.87% were male. 62 patients underwent surgery after staging EMR due to unresectable lesions, adverse histology, positive deep margins or recurrence. 87 patients were triaged straight to surgery due to multifocal disease, predicted invasive disease or unsuitability for endoscopic therapy. 135/149 had EUS and 139/149 had PET-CT. The rate of nodal metastasis was 14.1% (21/149), with T1b being the most common pathological stage amongst positive nodes. The recurrence rate is estimated to be 6.7% (10/149). At a median follow up of 54 months (range 0.13 months – 154 months) 80.54% of our cohort were alive and the Kaplan-Meier median survival was therefore not reached. Conclusions The observed rates of nodal metastasis and recurrence emphasise the importance of thorough staging and ongoing surveillance in this patient cohort at substantial risk of systemic recurrence. Further data on utility of adjuvant SACT in this cohort are required.