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CC BY 4.0 · Endoscopy 2025; 57(07): 699-708
DOI: 10.1055/a-2538-9316
Original article

Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study

Man Wai Chan
1   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
2   Cancer Centre Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
,
Rehan Haidry
4   Division of Gastroenterology and Hepatology, University College London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4919)
5   Digestive Diseases & Surgery Institute, Cleveland Clinic London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
Benjamin Norton 
4   Division of Gastroenterology and Hepatology, University College London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4919)
6   Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN591481)
,
Massimiliano di Pietro
7   Division of Gastroenterology and Hepatology, Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN2153)
8   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN2152)
,
Andreas V. Hadjinicolaou
7   Division of Gastroenterology and Hepatology, Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN2153)
8   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN2152)
,
Maximilien Barret
9   Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France (Ringgold ID: RIN26935)
,
Paul Doumbe Mandengue 
9   Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France (Ringgold ID: RIN26935)
,
Stefan Seewald
10   Center for Gastroenterology, Hirslanden Clinic, Zurich, Switzerland
,
Raf Bisschops 
11   Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (Ringgold ID: RIN60182)
,
Philippe Nafteux
12   Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium (Ringgold ID: RIN60182)
,
Michael J. Bourke
13   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Sunil Gupta 
13   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
,
Pradeep Mundre
14   Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN1906)
,
Arnaud Lemmers
15   Gastroenterology, Hepatopancreatology and Digestive Oncology, Hopital Erasme, Brussels, Belgium (Ringgold ID: RIN70496)
,
Clémence Vuckovic
15   Gastroenterology, Hepatopancreatology and Digestive Oncology, Hopital Erasme, Brussels, Belgium (Ringgold ID: RIN70496)
,
Oliver Pech
16   Gastroenterology, Regensburg Hospital of the Hospitaller Order of the Brothers of Saint John of God, Regensburg, Germany (Ringgold ID: RIN155897)
,
Philippe Leclercq
17   Gastroenterology, Clinique CHC Mont Légia, Liège, Belgium
,
Emmanuel Coron
18   Endoscopy and Gastroenterology, CHU Nantes, Nantes, France (Ringgold ID: RIN26922)
,
Sybren L. Meijer 
19   Histopathology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
,
Jacques J. G. H. M. Bergman 
1   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
2   Cancer Centre Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
,
Roos E. Pouw
1   Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)
2   Cancer Centre Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN571143)
3   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands (Ringgold ID: RIN571165)
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Abstract

Background

Post-endoscopic resection (ER) management of high risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastasis (LNM). We aimed to assess outcomes following radical ER for high risk T1 EAC.

Methods

We identified patients who underwent radical ER (tumor-negative deep margin) of high risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008 and 2019 across 11 international centers.

Results

106 patients (86 men; mean [SD] age, 70 [11] years) were included. Of these, 26 (age, 64 [11] years) underwent additional surgery, with residual T1 EAC found in five patients (19%) and LNM in two (8%). After a median [IQR] follow-up of 47 [32–79] months, 2/26 patients (8%) developed LNM/distant metastasis, with one EAC-related death (4%), one unrelated death (4%), and four patients lost to follow-up (15%). Of the 80 patients (age, 71 [9] years) who entered endoscopic surveillance, 5/80 (6%) developed LNM/distant metastasis, with four EAC-related deaths (5%) over 46 (IQR 25–59) months follow-up; there were 15 unrelated deaths (19%), and 10 patients lost to follow-up (13%). The overall rates (95%CI) were: LNM, 6% (2%–12%); LNM/distant metastasis, 7% (3%–13%); EAC-related mortality, 5% (2%–11%); overall mortality, 20% (95%CI 13–29).

Conclusion

Our findings present low rates of LNM after radical ER of high risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.

Supplementary Material



Publication History

Received: 11 May 2024

Accepted after revision: 12 February 2025

Accepted Manuscript online:
13 February 2025

Article published online:
28 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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