131 Endoscopic Mucosal Resection (EMR) for Early Oesophageal Cancer – the Experience of a Tertiary Oesopgagogastric Resectional Unit

Abstract Aim Endoscopic mucosal resection (EMR) is a key technique in the staging and endoscopic management of early oesophageal adenocarcinoma. We report our tertiary resection centre’s experience over a 7-year period. Method All oesophageal adenocarcinoma EMR specimens, received by pathology from a single centre, between 01/2015 and 12/2022 were included. Outcome measures include nodule size; number of mucosecotmies per nodule; Presence of Negative Prognostic Indicators (NPIs): 1) submucosal involvement (T1b) 2) involved deep margin (R1) 3) lymphovascular invasion (LVI); Subsequent Oesophagectomy and resection T/N-stage; overall/disease related mortality; outcomes by NPI; and EMR complications. Results 87 patients underwent 181 mucosectomies: mean 2.1 per nodule (1-6); pT1b > pT1a (2.6 vs 1.8). Examining NPIs, 37 patients (42.5%) were pT1b; 21 (24.3%) had LVI; 21 (24.7%) were R1 at the deep margin. Oesophagectomy was performed in 16 patients, with 5 oesophagectomy patients (31.3%) found to have positive nodes. NPIs were positive predictors for surgery (HR 6.2) and disease related mortality (HR 2.7). Submucosal involvement was the highest individual predictor for surgery (HR 4.41), disease related mortality (HR 4.05), and node positivity at resection (HR 1.5). In patients with no NPIs, 39 (95.1%) were successfully managed with endoscopy only, and disease related mortality was reduced in this group (HR 0.38). EMR complication rate was 4.5%: 0 perforations, 1 haemorrhage, 3 strictures, and no deaths. Conclusions EMR safely stages early oesophageal adenocarcinoma and, if no NPIs, avoids the need for oesophagectomy in most patients. With NPI - and submucosal invasion in particular - proceeding to oesophagectomy should be carefully considered.