Endoscopic resection in esophageal adenocarcinoma: a basic requirement for future management algorithms

Esophageal adenocarcinomas that are clinically staged as T2N0M0 remain a management dilemma for cancer care teams around the world. Patients with cT2N0M0 disease probably represent a heterogeneous group of true pathologic disease states including: (i) correctly staged “true” T2N0M0 disease; (ii) under-staged locally advanced disease (i. e. those with pathologic N1, T3, or aggressive grade tumors); and (iii) over-staged T1N0M0 disease. The challenge is deciphering into which group each individual patient with cT2N0M0 disease falls so that they can receive the appropriate initial therapy (endoscopic resection vs. surgical resection vs. neo-adjuvant chemoradiotherapy).

“…there is going to be a continued need for better methods to determine the best initial treatment method for patients with cT2N0M0 esophageal adenocarcinoma.”

• References

• 1 van Hagen P, Hulshof MC, van Lanschot JJ. et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. NEJM 2012; 366: 2074-2084
• 2 Gotink AW, Spaander MCW, Doukas M. et al. Exploring diagnostic and therapeutic implications of endoscopic mucosal resection in EUS-staged T2 esophageal adenocarcinoma. Endoscopy 2017; 49: 941-948
• 3 Ajani JA, D'Amico TA, Almhanna K. et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Canc Netw 2015; 13: 194-227
• 4 Lordick F, Mariette C, Haustermans K. et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: v50-v57
• 5 Bergeron EJ, Lin J, Chang AC. et al. Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg 2014; 147: 765-771 ; Discussion 71–73
• 6 Pech O, Gunter E, Dusemund F. et al. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 2010; 42: 456-461
• 7 Tekola BD, Sauer BG, Wang AY. et al. Accuracy of endoscopic ultrasound in the diagnosis of T2N0 esophageal cancer. J Gastrointest Cancer 2014; 45: 342-346
• 8 Trikudanathan G, Njei B, Attam R. et al. Staging accuracy of ampullary tumors by endoscopic ultrasound: meta-analysis and systematic review. Dig Endosc 2014; 26: 617-626
• 9 Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev 2015; Feb 6;(2) CD009944
• 10 Puli SR, Bechtold ML, Reddy JB. et al. How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Meta-analysis and systematic review. Ann Surg Oncol 2009; 16: 254-265
• 11 van Vliet EP, Eijkemans MJ, Poley JW. et al. Staging of esophageal carcinoma in a low-volume EUS center compared with reported results from high-volume centers. Gastrointest Endosc 2006; 63: 938-947
• 12 Markar SR, Mackenzie H, Ni M. et al. The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection. Gut 2016;
• 13 van Vliet EP, Eijkemans MJ, Kuipers EJ. et al. A comparison between low-volume referring regional centers and a high-volume referral center in quality of preoperative metastasis detection in esophageal carcinoma. Am J Gastroenterol 2006; 101: 234-242
• 14 Brusselaers N, Mattsson F, Lagergren J. Hospital and surgeon volume in relation to long-term survival after oesophagectomy: systematic review and meta-analysis. Gut 2014; 63: 1393-1400