Management of patients with T1b esophageal adenocarcinoma: a retrospective cohort study on patient management and risk of metastatic disease

Surgical Endoscopy And Other Interventional Techniques - Tập 30 - Trang 4102-4113 - 2016
Dirk Schölvinck1,2, Hannah Künzli1,2, Sybren Meijer3, Kees Seldenrijk4, Mark van Berge Henegouwen5, Jacques Bergman2, Bas Weusten1,2
1Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Nieuwegein, The Netherlands
2Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
3Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
4Department of Pathology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
5Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

Tóm tắt

Esophagectomy for submucosal (T1b) esophageal adenocarcinoma (EAC) is performed in order to optimize patient outcomes given the risk of concurrent lymph node metastases (LNM). However, not seldom, comorbidity precludes these patients from surgery. Therefore, the aim of our study was to assess the course of follow-up after treatment in submucosal EAC patients undergoing surgery versus conservative therapy and to evaluate the incidence of metastatic disease. Between 2001 and 2012, all patients undergoing diagnostic endoscopic resection for EAC in two centers were reviewed. Only patients with histopathologically proven submucosal tumor invasion were included. Submucosal EACs were divided into tumors that were removed radically (R0) and irradically (R1). Subsequently, in the R0 group, EACs were classified as either low risk (LR; submucosal invasion <500 nm, G1–G2, no LVI) or high risk (HR; deep submucosal invasion >500 nm, G3–G4 and/or LVI). Metastatic disease was defined as LNM in surgical resection specimen and/or evidence of malignant disease during follow-up (FU). Sixty-nine patients with a submucosal EAC were included [23 R1-resections and 46 R0-resection (14 R0-LR and 32 R0-HR)]. Twenty-six patients underwent surgical treatment (1 R0-LR, 12 R0-HR and 13 R1). None of the 14 R0-LR patients developed metastatic disease after a median FU of 60 months. In the R0-HR group and R1 group, metastatic disease was diagnosed in 16 and 30 % of patients, respectively. Surgical patients tended to have a better overall survival than non-surgical patients (p = 0.09). Tumor-related deaths, however, were 12 % in both groups. In LR submucosal EAC, the risk of metastatic disease appears to be very low. In deep submucosal EAC (either R0- or R1-resection), the rate of metastatic disease is lower than reported in earlier surgical series. Given the reasonable disease-free survival and high background mortality, conservative management of these patients seems to be a valid alternative for surgery in selected cases.

Tài liệu tham khảo

Pera M, Manterola C, Vidal O, Grande L (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92:151–159

Hur C, Miller M, Kong CY, Dowling EC, Nattinger KJ, Dunn M et al (2013) Trends in esophageal adenocarcinoma incidence and mortality. Cancer 119:1149–1158

Bennett C, Green S, Decaestecker J, Almond M, Barr H, Bhandari P et al (2012) Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett’s oesophagus. Cochrane Database Syst Rev 11:CD007334

Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN et al (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75:217–222

Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J et al (1998) Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339:1979–1984

Sanghera SS, Nurkin SJ, Demmy TL (2012) Quality of life after an esophagectomy. Surg Clin North Am 92:1315–1335

Blazeby JM, Farndon JR, Donovan J, Alderson D (2000) A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 88:1781–1787

Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BL et al (2016) Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 65:555–562

Phoa KN, Pouw RE, van Vilsteren FG, Sondermeijer CM, Ten Kate FJ, Visser M et al (2013) Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 145:96–104

May A, Gossner L, Pech O, Fritz A, Gunter E, Mayer G et al (2002) Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol 14:1085–1091

Peters FP, Kara MA, Rosmolen WD, Aalders MC, Ten Kate FJ, Bultje BC et al (2005) Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus. Gastrointest Endosc 61:506–514

Pech O, May A, Manner H, Behrens A, Pohl J, Weferling M et al (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(652–60):e1

Manner H, Pech O, Heldmann Y, May A, Pauthner M, Lorenz D et al (2015) The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc 29:1888–1896

Rice TW, Zuccaro G Jr, Adelstein DJ, Rybicki LA, Blackstone EH, Goldblum JR (1998) Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. Ann Thorac Surg 65:787–792

Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232:733–742

Westerterp M, Koppert LB, Buskens CJ, Tilanus HW, ten Kate FJ, Bergman JJ et al (2005) Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 446:497–504

Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C et al (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15:3278–3288

Alvarez Herrero L, Pouw RE, van Vilsteren FG, ten Kate FJ, Visser M, van Berge Henegouwen MI et al (2010) Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens. Endoscopy 42:1030–1036

Sepesi B, Watson TJ, Zhou D, Polomsky M, Litle VR, Jones CE et al (2010) Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg 210:418–427

Holscher AH, Bollschweiler E, Schroder W, Metzger R, Gutschow C, Drebber U (2011) Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg 254:802–807

Leers JM, DeMeester SR, Oezcelik A, Klipfel N, Ayazi S, Abate E et al (2011) The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg 253:271–278

Barbour AP, Jones M, Brown I, Gotley DC, Martin I, Thomas J et al (2010) Risk stratification for early esophageal adenocarcinoma: analysis of lymphatic spread and prognostic factors. Ann Surg Oncol 17:2494–2502

Prasad GA, Wu TT, Wigle DA, Buttar NS, Wongkeesong LM, Dunagan KT et al (2009) Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 137:815–823

Stein HJ, Feith M, Bruecher BL, Naehrig J, Sarbia M, Siewert JR (2005) Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 242:566–573

Buskens CJ, Westerterp M, Lagarde SM, Bergman JJ, ten Kate FJ, van Lanschot JJ (2004) Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 60:703–710

Boys JA, Worrell SG, Chandrasoma P, Vallone JG, Maru DM, Zhang L et al (2016) Can the risk of lymph node metastases be gauged in endoscopically resected submucosal esophageal adenocarcinomas? A multi-center study. J Gastrointest Surg 20:6–12

Fotis D, Doukas M, Wijnhoven BP, Didden P, Biermann K, Bruno MJ et al (2015) Submucosal invasion and risk of lymph node invasion in early Barrett’s cancer: potential impact of different classification systems on patient management. United European Gastroenterol J 3:505–513

Griffin SM, Burt AD, Jennings NA (2011) Lymph node metastasis in early esophageal adenocarcinoma. Ann Surg 254:731–736

Dubecz A, Kern M, Solymosi N, Schweigert M, Stein HJ (2015) Predictors of Lymph Node Metastasis in Surgically Resected T1 Esophageal Cancer. Ann Thorac Surg 99:1879–1885

Peters FP, Brakenhoff KP, Curvers WL, Rosmolen WD, Fockens P, ten Kate FJ et al (2008) Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus. Gastrointest Endosc 67:604–609

Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C et al (2011) Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg 11:2

Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

Gondrie JJ, Pouw RE, Sondermeijer CM, Peters FP, Curvers WL, Rosmolen WD et al (2008) Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients. Endoscopy 40:359–369

Pouw RE, Wirths K, Eisendrath P, Sondermeijer CM, Ten Kate FJ, Fockens P et al (2010) Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 8:23–29

van Vilsteren FG, Bergman JJ (2010) Endoscopic therapy using radiofrequency ablation for esophageal dysplasia and carcinoma in Barrett’s esophagus. Gastrointest Endosc Clin N Am 20:55–74 vi

Pech O, Gunter E, Dusemund F, Origer J, Lorenz D, Ell C (2010) Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 42:456–461

van Sandick JW, van Lanschot JJ, ten Kate FJ, Offerhaus GJ, Fockens P, Tytgat GN et al (2000) Pathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making. Cancer 88:2429–2437

Dresner SM, Lamb PJ, Bennett MK, Hayes N, Griffin SM (2001) The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction. Surgery 129:103–109

Nigro JJ, DeMeester SR, Hagen JA, DeMeester TR, Peters JH, Kiyabu M et al (1999) Node status in transmural esophageal adenocarcinoma and outcome after en bloc esophagectomy. J Thorac Cardiovasc Surg 117:960–968

Thông tin
Thông tin xuất bản

Surgical Endoscopy And Other Interventional Techniques

Tập 30

4102-4113

Thông tin tác giả