Aims:
The aim of this study was to assess outcomes of endoscopic treatment in patients with 'high-risk' early esophageal cancer (EEC). 'High-risk' cancer was defined as any cancer with sm invasion or mucosal cancer with at least one of the following: poor differentiation, invasion to blood or lymphatic vessels and high tumor cell dissociation. The main outcome measurement was tumor-free survival.
Methods:
A single-center, retrospective analysis of prospectively collected data. Patients with EEC underwent endoscopic resection or endoscopic submucosal dissection. Based on histopathological staging, patients with 'high-risk' EEC without contraindications were referred for surgery. The patients have been followed up for a median of 39 months (2 – 156).
Results:
A total of 56 patients with ‘high-risk’ EEC underwent endoscopic treatment: 21 patients (41%) had T1a cancer with ‘high-risk’ features and 35 patients (59%) had T1b cancer with sm invasion (sm1: 15, sm2: 9, sm3: 11); 19 patients were referred for surgery. A total of 37 patients (66%) continued in endoscopic treatment. Complete local remission (CLR) of neoplasia was achieved in 35/37 patients (95%). Tumor generalization occurred in 2 patients (one of them achieved CLR) 24 months after endoscopic treatment (both patients had sm3 invasion) and these patients are undergoing oncological treatment. All remaining patients with CLR (n = 33) have experienced neither local relapse nor generalization. Tumor-free survival was 89% in patients treated endoscopically and endoscopy related mortality was 0% (0/37).
Among 19 patients who were referred for esophagectomy, one patient presented with tumor generalization revealed during the operation. The remaining 18 patients underwent esophagectomy; local residua of malignancy were present in 5/18 patients. Lymph node (LN) metastases have not been detected in any patient among the 337 examined LNs.
Conclusions:
Endoscopic treatment provides long-term remission or cure in a considerable number of patients with ‘high-risk’ EEC and it may thus represent a valid alternative to surgery.
