Endoscopy 2019; 51(04): S77
DOI: 10.1055/s-0039-1681397
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ESD esophagus Congress Hall
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC TREATMENT VS. SURGERY IN PATIENTS WITH HIGH-RISK EARLY ESOPHAGEAL CANCER

M Kollar
1   Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
,
J Krajciova
2   IKEM, Prague, Czech Republic
,
J Maluskova
2   IKEM, Prague, Czech Republic
,
A Pazdro
3   University Hospital Motol, Prague, Czech Republic
,
T Harustiak
3   University Hospital Motol, Prague, Czech Republic
,
D Kodetova
3   University Hospital Motol, Prague, Czech Republic
,
Z Vackova
2   IKEM, Prague, Czech Republic
,
J Spicak
2   IKEM, Prague, Czech Republic
,
J Martinek
2   IKEM, Prague, Czech Republic
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
18. März 2019 (online)

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    Aims:

    Esophagectomy is a standard treatment for patients with 'high-risk' early esophageal cancer (EEC) despite a growing evidence that endoscopic treatment could be a safe alternative even for these patients.

    The aim was to prospectively assess results of endoscopic vs. surgical treatment in consecutive patients with 'high-risk' EEC. 'High-risk' cancer was defined as any cancer with sm invasion or mucosal cancer with at least one of the following: poor differentiation (G3/G4), invasion to blood (A+) or lymphatic vessels (L+) and high tumor cell dissociation (TCD3).

    Methods:

    Patients with EEC underwent endoscopic resection (ER) or submucosal dissection (ESD). Patients with 'high-risk' EEC without contraindications were referred for surgery. Remaining patients continued in endoscopic treatment, if necessary. After treatment, the patients have been followed up for a median of 52 months (range 2 – 168).

    Results:

    A total of 71 patients with 'high-risk' EEC underwent endoscopic treatment: 23 patients (32%) had T1a cancer with 'high-risk' features and 48 (68%) had T1b cancer with sm invasion; 53 had adenocarcinoma (EAC), 18 had squamous carcinoma (SCC); 24 patients (34%) were referred for surgery and 47 (66%) continued in endoscopic treatment.

    Endoscopy:

    Complete local remission (CLR) was achieved in 45/47 patients (95.7%). Two patients without CLR continued endoscopic therapy with a palliative intent. Tumor generalization occurred in 2 patients (both had sm3 invasion, A+, L+ and TCD3). All remaining patients with CLR (n = 43) have not experienced either local relapse or generalization. Tumor-free survival was 84 months.

    Surgery:

    Among 24 patients who were referred for esophagectomy, one patient had tumor generalization. The remaining 23 patients underwent esophagectomy; local residua of malignancy were present in 6/23 patients (26%) Surgery related mortality was 4.4% (1/23).

    Conclusions:

    Endoscopic treatment provides long-term remission (or cure) in considerable number of patients with high risk EAC and it may represent a valid alternative to surgery.


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