Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.763
Peer-review started: May 20, 2016
First decision: July 20, 2016
Revised: August 23, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: December 16, 2016
Processing time: 208 Days and 7.1 Hours
To investigate the outcomes and recurrences of pT1b esophageal adenocarcinoma (EAC) following endoscopic mucosal resection (EMR) and associated treatments.
Patients undergoing EMR with pathologically confirmed T1b EAC at two academic referral centers were retrospectively identified. Patients were divided into 4 groups based on treatment following EMR: Endoscopic therapy alone (group A), endoscopic therapy with either chemotherapy, radiation or both (group B), surgical resection (group C) or no further treatment/lost to follow-up (< 12 mo) (group D). Pathology specimens were reviewed by a central pathologist. Follow-up data was obtained from the academic centers, primary care physicians and/or referring physicians. Univariate analysis was performed to identify factors predicting recurrence of EAC.
Fifty-three patients with T1b EAC underwent EMR, of which 32 (60%) had adequate follow-up ≥ 12 mo (median 34 mo, range 12-103). There were 16 patients in group A, 9 in group B, 7 in group C and 21 in group D. Median follow-up in groups A to C was 34 mo (range 12-103). Recurrent EAC developed overall in 9 patients (28%) including 6 (38%) in group A (median: 21 mo, range: 6-73), 1 (11%) in group B (median: 30 mo, range: 30-30) and 2 (29%) in group C (median 21 mo, range: 7-35. Six of 9 recurrences were local; of the 6 recurrences, 5 were treated with endoscopy alone. No predictors of recurrence of EAC were identified.
Endoscopic therapy of T1b EAC may be a reasonable strategy for a subset of patients including those either refusing or medically unfit for esophagectomy.
Core tip: Endoscopic eradication therapy (EET) is reported as safe and effective for low risk T1b esophageal adenocarcinomas (EAC), but overall data is lacking. We retrospectively evaluated patients with T1b EAC treated with EET, EET with chemotherapy and/or radiation therapy and surgical resection. The overall recurrence rate was 28% at median 21 mo (range: 6-73) following EMR. In those treated with endoscopic mucosal resection alone, recurrence rate was 38% at median 21 mo (range: 6-73). Six of the 9 recurrences were local; 5 were treated with endoscopy alone. EET of T1b EAC may be a reasonable treatment strategy for a subset of these patients.