Mo1314 RISK OF GENERALIZATON IN PATIENTS WITH HIGH-RISK EARLY ESOPHAGEAL CANCER: A RETROSPECTIVE ANALYSIS OF PROSPECTIVELY COLLECTED DATA INCLUDING DETAILED ANALYSIS OF LYMPH NODE MICROMETASTASES

Abstract Esophagectomy is a standard of care for patients with "high-risk" early esophageal cancer (HRC) despite a growing evidence that endoscopic treatment may be a safe alternative. Our aims were 1. to prospectively evaluate the long-term results of endoscopic and surgical treatments in consecutive patients with HRC and 2. to determine the risk of lymph node (LN) metastases and micrometastases in patients with HRC. Methods HRC was defined as any cancer with submucosal (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 (TCD3). All patients (n = 69) underwent endoscopic resection (ER or ESD) and after the histopathological diagnosis of HRC, patients without contraindications were referred to surgery (n = 30). The remaining patients (n = 39) continued in endoscopic treatment, if necessary. All resected LNs were stained for hematoxylin–eosin to evaluate metastases and immunohistochemistry was used for the detection of micrometastases or isolated tumor cells. Results Eighteen patients (26%) had T1a and 51 (74%) had T1b cancer; 51 had adenocarcinoma (AC) and 18 had squamous cell carcinoma (SCC). The median follow-up was 32 months (3–120). No patient with mucosal invasion (15 AC, 3 SCC) experienced LN involvement. Among 17 patients with sm1 invasion, only 2 (12%, both AC)experienced generalization or LN involvement. The further rates of LN involvement were 0% (0/5) in sm2 AC, 50% (3/6) in sm2 SCC, 25% (4/16) in sm3 AC and 29% (2/7) in sm3 SCC. 60% (18/30) of surgically treated patients would have been completely cured by endoscopy (Table 1). Conclusion The risk of LN metastases/micrometastases was lower than expected. No patients with high-risk mucosal cancer or low-risk sm1 cancer experienced lymph node involvement. Endoscopic treatment provided long-term remission (or cure) in considerable number of patients and it may represent a valid alternative to surgery in patients with high-risk early esophageal cancer.

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Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement

Cancers ◽

10.3390/cancers12123598 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3598

Author(s):

Solène Dermine ◽

Thomas Lévi-Strauss ◽

Einas Abou Ali ◽

Arthur Belle ◽

Sarah Leblanc ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

High Risk ◽

Endoscopic Resection ◽

Lymph Node Involvement ◽

Muscularis Mucosa ◽

Early Esophageal Cancer ◽

Poor Differentiation ◽

Node Involvement

Background: Esophagectomy is recommended after endoscopic resection of an early esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. Patients and Methods: This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by chemoradiotherapy or follow-up in case of surgical contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS), cancer specific survival (CSS) and toxicity of chemoradiotherapy. Results: Forty-one patients (36 with squamous cell carcinoma and 5 with adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by chemoradiotherapy or radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the chemoradiotherapy group at the end of the follow-up. Serious adverse events related to chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. Conclusions: Our study shows that close follow-up may be an alternative to systematic esophagectomy after endoscopic resection of early esophageal cancer with a predicted high risk of lymph node involvement.

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Endoscopic detection of early esophageal cancer in a high risk population. Does the lugol coloration improve the results of video-endoscopic examination?

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(05)80279-2 ◽

1995 ◽

Vol 41 (4) ◽

pp. 356

Author(s):

V. Meyer ◽

P. Burtin ◽

B. Bour ◽

A. Blanchi ◽

F. Oberti ◽

...

Keyword(s):

Esophageal Cancer ◽

High Risk ◽

Endoscopic Examination ◽

High Risk Population ◽

Early Esophageal Cancer ◽

Risk Population

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PS02.022: INDOCYANINE GREEN: A USEFUL TOOL IN MINIMALLY INVASIVE ESOPHAGEAL CANCER SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.022 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 126-126

Author(s):

Victor Turrado-Rodriguez ◽

Dulce Nombre De Maria Momblan ◽

Ainitze Ibarzabal ◽

Alba Torroella ◽

Rafael Gerardo Diaz Del Gobo ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Indocyanine Green ◽

Esophageal Surgery ◽

Gastric Conduit ◽

Early Esophageal Cancer ◽

Regional Lymph Nodes ◽

Vascular Assessment

Abstract Background Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras. Methods A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above. Results The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed. Conclusion ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer Disclosure All authors have declared no conflicts of interest.

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RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 41-41

Author(s):

Xiaofeng Duan ◽

Zhentao Yu

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Location ◽

Individual Risk ◽

Node Dissection ◽

Early Esophageal Cancer ◽

Node Metastasis ◽

The Individual

Abstract Background Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation. Methods We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis. Results In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%. Conclusion T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy. Disclosure All authors have declared no conflicts of interest.

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