Endoscopy 2020; 52(S 01): S128-S129
DOI: 10.1055/s-0040-1704395
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

LONG-TERM OUTCOME OF SALVAGE ENDOSCOPIC RESECTION AFTER DEFINITIVE CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER: A WESTERN EXPERIENCE

A Al-Kaabi
1   Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, Netherlands
,
RHA Verhoeven
2   Netherlands Comprehensive Cancer Organization, Department of Research & Development, Utrecht, Netherlands
3   Radboud University Medical Center, Department of Surgery, Nijmegen, Netherlands
,
PH Deprez
4   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Department of Gastroenterology, Brussels, Belgium
,
S Seewald
5   Klinik Hirslanden, Center of Gastroenterology, Zurich, Switzerland
,
M Giovannini
6   Institut Paoli-Calmettes, Endoscopic Unit, Marseille, France
,
B Braden
7   Oxford University Hospitals NHS Foundation Trust, Translational Gastroenterology Unit, Oxford, UK
,
EJ Schoon
8   Catharina Hospital, Department of Gastroenterology and Hepatology, Eindhoven, Netherlands
,
F Berr
9   Paracelsus Medical University, Department of Medicine, Salzburg, Austria
,
A Lemmers
10   Erasme University Hospital, Université Libre de Brussels, Department of Gastroenterology, Brussels, Belgium
,
J Hoare
11   Imperial College NHS Trust, Department of Gastroenterology, London, UK
,
P Bhandari
12   Portsmouth Hospitals NHS Trust, Department of Gastroenterology, Portsmouth, UK
,
RS van der Post
13   Radboud University Medical Center, Department of Pathology, Nijmegen, Netherlands
,
PD Siersema
1   Radboud University Medical Center, Gastroenterology and Hepatology, Nijmegen, Netherlands
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Publikationsdatum:
23. April 2020 (online)

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Aims Definitive chemoradiotherapy (dCRT) is increasingly used as non-surgical treatment for oesophageal cancer. Local failure after dCRT at the primary site is common and remains a major challenge. In Japanese series, salvage endoscopic resection (ER) has emerged as promising treatment modality for superficial residual/recurrent lesions after dCRT. Comparable data from outside Japan are scarce. The primary aim was to evaluate the safety and long-term efficacy of salvage ER in a Western case series.

Methods Gastroenterologists from endoscopic centres in Europe were invited to check their institutional databases for salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) cases following dCRT. Participating gastroenterologists completed an anonymized database, including patient’s demographics and clinicopathological variables. All patients were followed up for recurrent locoregional or distant disease after salvage ER.

Results Nine endoscopic centres in 6 European countries submitted information on 22 patients (16 males, 6 females), with a median age of 72 years (IQR:69-76). A total of 27 salvage ER procedures were performed, of which 20 (74%) were ESD and 7 (26%) EMR. The majority of patients had squamous cell carcinoma (64%) of the middle or distal oesophagus (72%), clinically staged as cT2-3 (64%) or cN+ (50%) prior to dCRT. Median time from end of dCRT to ER was 19 months (IQR:5-45). En-bloc resection rate was 100% for ESD and 57% for EMR. During a median of 32 months (IQR:13-64) follow-up after salvage ER, 55% developed a recurrence (9 locoregional, 3 distant). The 5-year recurrence-free survival, overall survival and disease-specific survival rates were 34%, 67% and 82%, respectively. No major complications, such as bleeding or perforation were reported. Only 2 patients developed a stricture during follow-up.

Conclusions In carefully selected patients with local residual or recurrent disease after dCRT, salvage ER seems to be a safe and effective non-surgical treatment option with favourable long-term disease-specific survival.