Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2018; 24(41): 4698-4707
Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4698
Risk of lymph node metastases in patients with T1b oesophageal adenocarcinoma: A retrospective single centre experience
David Graham, Nejc Sever, Cormac Magee, William Waddingham, Matthew Banks, Rami Sweis, Hannah Al-Yousuf, Miriam Mitchison, Durayd Alzoubaidi, Manuel Rodriguez-Justo, Laurence Lovat, Marco Novelli, Marnix Jansen, Rehan Haidry
David Graham, Nejc Sever, Cormac Magee, William Waddingham, Matthew Banks, Rami Sweis, Hannah Al-Yousuf, Miriam Mitchison, Durayd Alzoubaidi, Manuel Rodriguez-Justo, Laurence Lovat, Marco Novelli, Marnix Jansen, Rehan Haidry, GI Services, University College London Hospital, London NW1 2BU, United Kingdom
David Graham, William Waddingham, Laurence Lovat, Marnix Jansen, Rehan Haidry, Division of Surgery and Science, University College London, London WC1E 6BT, United Kingdom
Nejc Sever, Gastroenterology Department, University Medical Center Ljubljana, Slovenia
Cormac Magee, Department of Metabolism and Experimental Therapeutics, University College London, London WC1E 6BT, United Kingdom
Author contributions: Graham D, Sever N and Haidry R designed the research, analysed data and wrote the paper; Magee C, Banks M, Sweis R, Lovat L, Novelli M, Jansen M and Haidry R designed the research, analysed data and reviewed paper; Waddingham W, Al-Yousuf H, Mitchison M and Rodriguez-Justo M designed the research and analysed data.
Institutional review board statement: The institutional review board approval was waived. However, this work was undertaken as a retrospective audit of patient care as part of service evaluation under the authorization of our local audit and governance guidelines.
Informed consent statement: Patients were not required to give informed consent to this study as the analysis used anonymous data that were obtained after each patient had agreed to to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: I, Dr Rehan Haidry, Consultant Gastroenterologist and Honorary Senior Lecturer at University College Hospital, London confirm that our article contains all relevant features outlined in the STROBE checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David Graham, BSc, MBBS, MRCP, Doctor, GI Services, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom. david.graham14@nhs.net
Telephone: +44-203-4477488 Fax: +44-203-4479217
Received: August 1, 2018
Peer-review started: August 1, 2018
First decision: August 24, 2018
Revised: September 29, 2018
Accepted: October 16, 2018
Article in press: October 16, 2018
Published online: November 7, 2018
Processing time: 98 Days and 14.9 Hours
Abstract
AIM

To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.

METHODS

Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymph-node metastases, disease-specific mortality and overall survival.

RESULTS

A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with high-risk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).

CONCLUSION

T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good out-comes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.

Keywords: Oesophageal adenocarcinoma; Submucosal invasion; T1b; Lymph node metastasis; Risk prediction; Endoscopy

Core tip: Our retrospective cohort data supports previously published work demonstrating that endoscopic therapy is a safe and effective option for T1b oesophageal adenocarcinoma without markers of high-risk for lymph-node metastasis. Furthermore, our work suggests that endoscopic therapy is a viable alternative to surgery in selected patients with high-risk lesions (particularly those with poor performance status) and highlights the need for further work exploring whether endoscopic therapy could be a viable option for all submucosal lesions.