Outcomes for Endoscopic Submucosal Dissection of Pathologically Staged T1b Esophageal Cancer: A Multicenter Study

Authors

Abel Joseph
Peter V Draganov
Fauze Maluf-Filho
Hiroyuki Aihara
Norio Fukami
Neil R Sharma
Amitabh Chak
Dennis Yang
Salmaan Jawaid
John Dumot
Omar Alaber
Tiffany Chua
Rituraj Singh
Lady Katherine Mejia-Perez
Ruishen Lyu
Xuefeng Zhang
Suneel Kamath
Sunguk Jang
Sudish Murthy
John Vargo
Amit Bhatt

Publication Date

9-1-2022

Journal

Gastrointestinal Endoscopy

DOI

10.1016/j.gie.2022.02.018

PMID

35217020

PMCID

PMC9488538

PubMedCentral® Posted Date

9-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Brazil, Endoscopic Mucosal Resection, Esophageal Neoplasms, Humans, Neoplasm Recurrence, Local, Neoplasm, Residual, Retrospective Studies, Treatment Outcome

Abstract

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.