Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer: a multicenter retrospective study - 20/04/24

Doi : 10.1016/j.gie.2023.11.047

Abel Joseph, MD ¹, Kornpong Vantanasiri, MD ², Peter V. Draganov, MD ³, William King, MD ³, Fauze Maluf-Filho, MD, PhD ^4,^5,⁶, Mohammad Al-Haddad, MD ⁷, Hashem Albunni, MD ⁷, Norio Fukami, MD ⁸, Sonmoon Mohapatra, MD ⁸, Hiroyuki Aihara, MD, PhD ⁹, Neil R. Sharma, MD ¹⁰, Amitabh Chak, MD ¹¹, Dennis Yang, MD ¹², Rituraj Singh, MD ¹⁰, Sunguk Jang, MD ¹³, Suneel Kamath, MD ¹⁴, Siva Raja, MD, PhD ¹⁵, Sudish Murthy, MD, PhD ¹⁵, Qijun Yang, MS ¹⁶, Prasad Iyer, MD ², Amit Bhatt, MD ^11,^⁎
¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
² Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
³ Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
⁴ Instituto do Cancer do Estado de São Paulo, Sao Paulo, Brazil
⁵ Department of Gastroenterology of University of Sao Paulo, Sao Paulo, São Paulo, Brazil
⁶ National Council for Scientific and Technological Development, Lago Sul, Brazil
⁷ Department of Gastroenterology, Indiana University, Indianapolis, USA
⁸ Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
⁹ Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
¹⁰ Division of Interventional Oncology and Surgical Endoscopy, Parkview Cancer Institute, Fort Wayne, Indianapolis, USA
¹¹ Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
¹² Department of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA
¹³ Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
¹⁴ Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio, USA
¹⁵ Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
¹⁶ Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

^∗Reprint requests: Amit Bhatt, MD, Cleveland Clinic Main Campus, Mail Code A31, 9500 Euclid Avenue, Cleveland, OH 44195.Cleveland Clinic Main Campus, Mail Code A31, 9500 Euclid Avenue, Cleveland, OH 44195

Abstract

Background and Aims

Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC.

Methods

Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs.

Results

A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008).

Conclusion

Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.

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Graphical abstract

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Abbreviations : EAC, EC, ESCC, ESD, cESD, LVI, SM, Tr-ESD, VM

Mappa

Classification of ESD procedures

Histopathologic analysis

Endpoints

Statistical analysis

Results

Patient and procedure characteristics

Drs Joseph and Vantanasari are co-first authors of this work. Drs Iyer and Amit Bhatt are co-senior authors of this work.

Esportazione

Vol 99 - N° 5

P. 694-701 - maggio 2024 Ritorno al numero

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Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer: a multicenter retrospective study - 20/04/24

Abstract

Background and Aims

Methods

Results

Conclusion

Graphical abstract

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