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DOI: 10.1055/a-2538-9316
Outcomes after radical endoscopic resection of high risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study
Autor*innen
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.
Publikationsverlauf
Eingereicht: 11. Mai 2024
Angenommen nach Revision: 12. Februar 2025
Accepted Manuscript online:
13. Februar 2025
Artikel online veröffentlicht:
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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