Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study

Published:February 22, 2022DOI:https://doi.org/10.1016/j.gie.2022.02.018

      Background and Aims

      The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC.

      Methods

      We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates.

      Results

      Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023).

      Conclusions

      EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.

      Abbreviations:

      CRT (chemoradiation therapy), EAC (esophageal adenocarcinoma), EC (esophageal cancer), ESCC (esophageal squamous cell carcinoma), ESD (endoscopic submucosal dissection), LVI (lymphovascular invasion)
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      Linked Article

      • T1b esophageal cancer: Is it time for endoscopic submucosal dissection to enter the stage?
        Gastrointestinal EndoscopyVol. 96Issue 3
        • Preview
          Esophageal endoscopic submucosal dissection (ESD) was initially pioneered and developed in Japan predominantly for the treatment of superficial esophageal squamous cell cancer (ESCC). In the past decade, there has been growing interest in esophageal ESD in the West, where esophageal adenocarcinoma (EAC) remains dominant over ESCC, which has seen an overall decline in the past few decades. Endoscopic resection in Barrett’s esophagus (BE) has been well validated as an important tool that can provide staging, prognosis, and eradication of BE-associated neoplasia and is uniformly recommended across societal guidelines for the management of high-grade dysplasia (HGD) and tumors confined to the muscularis mucosa (T1a).
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