Endoscopic submucosal dissection for early esophageal adenocarcinoma: low rates of metastases in mucosal cancers with poor differentiation - 16/10/24
, Felix Kappler, MD 1, Alanna Ebigbo, MD 1, David Albers, MD 2, Siegbert Faiss, MD 3, Ingo Steinbrück, MD 4, 5, Andreas Wannhoff, MD 6, Hans-Peter Allgaier, MD 5, Ulrike Denzer, MD 7, Viktor Rempel, MD 8, Roland Reinehr, MD 9, Dani Dakkak, MD 2, Matthias Mende, MD 3, Jürgen Pohl, MD 10, Tina Schaller, MD 11, Bruno Märkl, MD 11, Anna Muzalyova, MD 1, Carola Fleischmann, MD 1, 12, Helmut Messmann, MD 1Abstract |
Background and Aims |
Endoscopic resection is accepted as standard treatment for intramucosal esophageal adenocarcinoma (EAC) that is well or moderately differentiated. Poor differentiation (PD) is judged as a risk factor for lymph node metastasis (LNM), and surgery is recommended. However, the evidence for this recommendation is weak. The aim of this study was to analyze the clinical course of patients after endoscopic resection of EAC with PD.
Methods |
Patients undergoing endoscopic submucosal dissection for EAC were included from 16 German centers. Inclusion criteria were PD in the resection specimen, R0 resection, and endoscopic follow-up. Primary outcome was the metastasis rate during follow-up. Analysis was performed retrospectively in a prospectively collected database.
Results |
Twenty-five patients with PD as single risk factor (group A) and 15 patients with PD and additional risk factors (submucosal invasion and/or lymphovascular invasion) (group B) were included. The metastasis rate was was 1 of 25 (4.0%; 95% CI, .4%-17.2%) in group A and 3 of 15 (20.0%; 95% CI, 6.0%-44.4%) in group B, respectively (P = .293). The rate of EAC-associated deaths was 1 of 25 (4%; 95% CI, .4%-17.2%) versus 3 of 15 (20%; 95% CI, 6.0%-44.4%) in group B (P = .293). The overall death rate was 7 of 25 (28.0%; 95% CI, 13.5%-47.3%) versus 3 of 15 (20%; 95% CI, 6.0%-44.4%) (P = .715). Median follow-up was 30 months (interquartile range, 15-53 months).
Conclusions |
During long-term follow-up, the risk of metastasis is low after endoscopic resection of mucosal EAC with PD as a single risk factor. A conservative approach seems justified in this small patient group. However, the treatment strategy must be determined on an individualized basis until further prospective data are available.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Abbreviations : APC, EAC, ESD, HM, IQR, LNM, LVI, PD, RFA, SM, VM
Mappa
Vol 100 - N° 4
P. 626-636 - ottobre 2024 Ritorno al numero
Articolo precedente
- Computer-aided diagnosis improves characterization of Barrett’s neoplasia by general endoscopists (with video)
- Jelmer B. Jukema, Carolus H.J. Kusters, Martijn R. Jong, Kiki N. Fockens, Tim Boers, Joost A. van der Putten, Roos E. Pouw, Lucas C. Duits, Bas L.A.M. Weusten, Lorenza Alvarez Herrero, Martin H.M.G. Houben, Wouter B. Nagengast, Jessie Westerhof, Alaa Alkhalaf, Rosalie Mallant-Hent, Pieter Scholten, Krish Ragunath, Stefan Seewald, Peter Elbe, Francisco Baldaque Silva, Maximilien Barret, Jacobo Ortiz Fernández-Sordo, Guiomar Moral Villarejo, Oliver Pech, Torsten Beyna, Nahid S.M. Montazeri, Fons van der Sommen, Peter H. de With, A. Jeroen de Groof, Jacques J. Bergman, BONS-AI consortium, Alaa Alkhalaf, Lorenza Alvarez Herrero, Francisco Baldaque-Silva, Maximilien Barret, Jacques J. Bergman, Torsten Beyna, Raf Bisschops, Tim G. Boers, Wouter Curvers, Pierre H. Deprez, Lucas C. Duits, Peter Elbe, Jose Miguel Esteban, Gary W. Falk, Kiki N. Fockens, Gregory G. Ginsberg, Albert J. de Groof, Rehan Haidry, Martin H. Houben, Anthony Infantolino, Prasad G. Iyer, Martijn Jong, Pieter-Jan de Jonge, Jelmer B. Jukema, Arjun Koch, Srinadh Komanduri, Vani Konda, Koen C. Kusters, Philippe Leclerq, Cadman L. Leggett, Charles J. Lightdale, Rosalie C. Mallant-Hent, Guiomar Moral Villarejo, Jacobo Ortiz Fernández-Sordo, Oliver Pech, Ian Penman, Roos E. Pouw, Joost A. van der Putten, Krish Ragunath, Pieter Scholten, Stefan Seewald, Amritha Sethi, Michael S. Smith, Fons van der Sommen, Arvind Trindade, Sachin Wani, Irving Waxman, Jessie Westerhof, Bas L. Weusten, Peter H. de With, Herbert C. Wolfsen
- Mobile health technology in pediatric EGD quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition
- Lorenzo Norsa, Francesco Morotti, Cecilia Mantegazza, Milena Meroni, Marco Deganello Saccomani, Claudia Banzato, Barbara Parma, Giulia Franchino, Giovanni Di Nardo, Naire Sansotta, Paolo Orizio, Emanuele Dabizzi, Giorgio Raffaele Fava, Andrea Chiaro, Maristella Pellegrino, Fabiola Fornaroli, Antonio Pizzol, Caterina Strisciuglio, Caterina Pacenza, Jacopo Barp, Cosimo Ruggiero, Giusy Russo, Salvatore Oliva
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?