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Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma?: A Propensity-matched Analysis

Lookup NU author(s): Professor Alexander PhillipsORCiD


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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. OBJECTIVE: The aim of this study was to evaluate the outcome of endoscopic resection (ER) versus esophagectomy in node-negative cT1a and cT1b esophageal adenocarcinoma. SUMMARY OF BACKGROUND DATA: The role of ER in the management of subsets of clinical T1N0 esophageal adenocarcinoma is controversial. METHODS: Data from the National Cancer Database (2010-2015) were used to identify patients with clinical T1aN0 (n = 2545) and T1bN0 (n = 1281) esophageal adenocarcinoma that received either ER (cT1a, n = 1581; cT1b, n = 335) or esophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching and Cox analyses were used to account for treatment selection bias. RESULTS: ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b esophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to esophagectomy [hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.70-1.04, P = 0.1]. The corresponding 5-year survival for ER and esophagectomy were 70% and 74% (P = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66-1.14, P = 0.3). The corresponding 5-year survival for ER and esophagectomy were 53% versus 61% (P = 0.3), respectively. CONCLUSIONS: This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 esophageal adenocarcinoma. However, 15% of patients with cT1b esophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from esophagectomy with lymphadenectomy.

Publication metadata

Author(s): Kamarajah SK, Phillips AW, Hanna GB, Low DE, Markar SR

Publication type: Article

Publication status: Published

Journal: Annals of Surgery

Year: 2022

Volume: 275

Issue: 4

Pages: 700-705

Print publication date: 01/04/2022

Online publication date: 11/06/2020

Acceptance date: 02/04/2018

ISSN (print): 0003-4932

ISSN (electronic): 1528-1140

Publisher: Lippincott Williams & Wilkins


DOI: 10.1097/SLA.0000000000004038

PubMed id: 32541217


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