Endoscopy 2020; 52(S 01): S127
DOI: 10.1055/s-0040-1704390
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Esophageal therapy: No limits?! Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

ORGAN PRESERVATION AFTER ENDOSCOPIC RESECTION OF AN EARLY ESOPHAGEAL CANCER WITH A HIGH RISK OF LYMPH NODE METASTASES

S Dermine
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
T Levi-Strauss
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
EA Ali
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
A Belle
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
S Leblanc
2   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Endoscopy, Paris, France
,
G Rahmi
3   Georges Pompidou European Hospital, Gastroenterology and Digestive Endoscopy, Paris, France
,
A Berger
3   Georges Pompidou European Hospital, Gastroenterology and Digestive Endoscopy, Paris, France
,
F Prat
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
R Coriat
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
S Chaussade
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
,
M Barret
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology and Digestive Oncology, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Esophagectomy is recommended after endoscopic resection of a T1 esophageal cancer in case of deep mural invasion or poor histoprognostic factors. However, this surgery is highly morbid, and no advanced residual neoplasia is found in up to 87% of resection specimens. We aimed to assess the outcomes of patients with an endoscopically resected T1 esophageal cancer considered at high risk of lymph node metastases that were managed non-operatively.

Methods We conducted a retrospective study in two centers between 2010 and 2019, including patients with a histologically complete endoscopic resection of a T1 esophageal cancer and: poorly differentiated cancer, lymphovascular invasion, m3 histology for squamous cell carcinoma (SCC) and submucosal invasion >500um for adenocarcinomas (ADC). Patients had declined or were unfit for esophageal resection.

Results 41 patients, among which 36 SCC and 5 ADC, with a median (IQR) age of 65 (47 - 85) were included. Criteria for inclusion were: poor differentiation (n=10), lymphovascular invasion (n=11), deep mural invasion (n= 33). 13 (32%) patients were followed up, 20 (49%) were treated by chemoradiotherapy (CRT) and 8 (20%) by radiotherapy (RT). Recurrence free survival was 98%: 100% (13/13) in the surveillance group and 96% (27/28) in the (C)RT group, with a median (IQR) follow-up of 12 (5 - 43) and 28 (3 - 71) months, respectively. Overall survival was 83%: 92% in the surveillance group and 79% in the (C)RT group. The only recurrence was a local recurrence, treated by rescue surgery, without late recurrence. Grade 3 or 4 toxicities occurred in 10% of patients of the (C)RT group and included radiation esophagitis and hematologic toxicity. No treatment related death was observed.

Conclusions Our data suggest that close follow-up could be an acceptable option after complete endoscopic resection of a T1 esophageal cancer currently considered at high risk of lymph node metastases.