Esophagectomy Following Endoscopic Resection of Submucosal Esophageal Cancer: a Highly Curative Procedure Even with Nodal Metastases

Molena, Daniela; Schlottmann, Francisco; Boys, Joshua A.; Blackmon, Shanda H.; Dickinson, Karen J.; Dunst, Christy M.; Hofstetter, Wayne L.; Lada, Michal J.; Louie, Brian E.; Mungo, Benedetto; Watson, Thomas J.; DeMeester, Steven R.

doi:10.1007/s11605-016-3210-3

Cited by 38 publications

(28 citation statements)

References 37 publications

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“…The survival with esophagectomy reported in that study is similar to what has been shown in other series of esophagectomy for T1b adenocarcinoma. 8,13 The authors of this current study report that in 39 patients (57%), the esophagectomy specimen showed residual disease, and 10 patients (15%) had lymph node metastases. On multivariable analysis, the hazard ratio for overall mortality with esophagectomy was 0.22, and in patients with at least 1 high-risk histologic feature the hazard ratio for overall mortality with esophagectomy was 0.12.…”

mentioning

confidence: 55%

“…Furthermore, in that study, operative mortality was zero, and disease-specific survival was 88% at 5 years. 8 Given these excellent results, esophagectomy is currently considered the optimal curative treatment strategy for clinically fit patients with T1b submucosal cancer, particularly when risk factors for node metastases are present. Further, long-term quality of life after esophagectomy has been shown to be excellent.…”

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confidence: 99%

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When less is just less: endoscopic therapy for submucosal T1b esophageal cancer

Molena

DeMeester

2020

Gastrointestinal Endoscopy

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confidence: 55%

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confidence: 99%

When less is just less: endoscopic therapy for submucosal T1b esophageal cancer

Molena

DeMeester

2020

Gastrointestinal Endoscopy

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“…Additional treatments for SEC patients with SM or LV invasion after ER are currently accepted as the appropriate course. Although guidelines for selecting the additional therapy are limited, esophagectomy or chemoradiotherapy are typical modalities [ 20 - 22 ]. However, there are few clinical data on the benefits of additional treatment in terms of the long-term prognosis of non-curatively resected SEC patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series

et al. 2018

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Background/AimsTo report the long-term survival and tumor recurrence outcomes in patients with superficial esophageal cancer (SEC) after complete non-curative endoscopic resection (ER). MethodsWe retrieved ER data for 24 patients with non-curatively resected SEC. Non-curative resection was defined as the presence of submucosal and/or lymphovascular invasion on ER pathology. Relevant clinical and tumor-specific parameters were reviewed. ResultsThe mean age of the 24 study patients was 66.3±8.3 years. Ten patients were closely followed up without treatment, while 14 received additional treatment. During a mean follow-up of 59.0±33.2 months, the 3- and 5-year survival rates of all cases were 90.7% and 77.6%, respectively. The 5-year overall survival rates were 72.9% in the close observation group and 82.1% in the additional treatment group (p=0.958). The 5-year cumulative incidences of all cases of recurrence (25.0% vs. 43.3%, p=0.388), primary EC recurrence (10.0% vs. 16.4%, p=0.558), and metachronous EC recurrence (16.7% vs. 26.7%, p=0.667) were similar between the two groups. ConclusionsPatients with non-curatively resected SEC showed good long-term survival outcomes. Given the similar oncologic outcomes, close observation may be an option with appropriate caution taken for patients who are medically unfit to receive additional therapy.

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“…In patients with early esophageal cancer (high‐grade dysplasia (Tis), mucosal (T1a), and submucosal cancer (T1b)), endoscopic therapy (endoscopic mucosal resection, as well as endoscopic submucosal dissection) is highly successful and is the preferred therapeutic approach . Depending on several histopathological parameters of the resected specimen, such as irradicality, the presence of lymphovascular invasion, deeper submucosal tumor invasion, and poor differentiation, subsequent surgical resection is indicated . In patients not eligible for surgery, endoscopic therapy followed by chemotherapy or chemoradiotherapy might be considered as an alternative treatment.…”

Section: Patient Selection For Surgerymentioning

confidence: 99%

“…2,8,9 Depending on several histopathological parameters of the resected specimen, such as irradicality, the presence of lymphovascular invasion, deeper submucosal tumor invasion, and poor differentiation, subsequent surgical resection is indicated. 1,10,11 In patients not eligible for surgery, endoscopic therapy followed by chemotherapy or chemoradiotherapy might be considered as an alternative treatment.…”

Section: Patient Selection For Surgerymentioning

confidence: 99%

Surgical treatment of esophageal cancer in the era of multimodality management

Borggreve

Kingma

Домрачев

et al. 2018

Annals of the New York Academy of Sciences

115

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Over the last decades, the treatment of resectable esophageal cancer has evolved into a multidisciplinary process in which all players are essential for treatment to be successful. Medical oncologists and radiation oncologists have been increasingly involved since the implementation of neoadjuvant therapy, which has been shown to improve survival. Although esophagectomy is still considered the cornerstone of curative treatment for locally advanced esophageal cancer, it remains associated with considerable postoperative morbidity, despite promising results of minimally invasive techniques. In this light, both physical status and response to neoadjuvant therapy may be important factors for selecting patients who will benefit from surgery. Furthermore, it is important to optimize the entire perioperative trajectory: from the initial outpatient clinic visit to postoperative discharge. Enhanced recovery after surgery is increasingly recognized for esophagectomy and emphasizes perioperative aspects, such as nutrition, physiotherapy, and pain management. To date, several facets of esophageal cancer treatment remain topics of debate, such as the preferred neoadjuvant treatment, anastomotic technique, extent of lymphadenectomy, organization of postoperative care, and the role of surgery beyond locally advanced disease. Here, we describe the current and future perspectives in the surgical treatment of patients with esophageal cancer in the context of the available literature.

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Esophagectomy Following Endoscopic Resection of Submucosal Esophageal Cancer: a Highly Curative Procedure Even with Nodal Metastases

Abstract: Esophagectomy is curative in the majority of patients with submucosal tumors even in the presence of nodal metastases. These data serve as a benchmark for comparison when considering extending the indications for therapeutic endoscopic resection for submucosal tumors in the future.

Cited by 38 publications

References 37 publications

When less is just less: endoscopic therapy for submucosal T1b esophageal cancer

When less is just less: endoscopic therapy for submucosal T1b esophageal cancer

Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series

Surgical treatment of esophageal cancer in the era of multimodality management

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