ORGAN PRESERVATION AFTER ENDOSCOPIC RESECTION OF AN EARLY ESOPHAGEAL CANCER WITH A HIGH RISK OF LYMPH NODE METASTASES

2020 ◽  
Author(s):  
S Dermine ◽  
T Levi-Strauss ◽  
EA Ali ◽  
A Belle ◽  
S Leblanc ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Endoscopic Resection ◽  
Lymph Node Metastases ◽  
Organ Preservation ◽  
Early Esophageal Cancer ◽  
Node Metastases

scholarly journals Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer

2019 ◽  
Vol 12 ◽  
pp. 175628481989255 ◽  
Author(s):  
Solène Dermine ◽  
Mahaut Leconte ◽  
Sarah Leblanc ◽  
Bertrand Dousset ◽  
Benoit Terris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Endoscopic Resection ◽  
Lymph Node Metastases ◽  
Early Esophageal Cancer ◽  
Cancer Specific Survival ◽  
Node Metastases ◽  
Disease Free

Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. Patients and methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins ( n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion ( n = 3 and 9), adenocarcinoma with deep submucosal invasion ( n = 11), poorly differentiated tumor ( n = 6) and lymphovascular invasion ( n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status ( n = 3) or lymph node metastases ( n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.

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

Cancers ◽  
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.

T1565 Prediction of Lymph Node Metastases in Early Esophageal Cancer

2009 ◽  
Vol 136 (5) ◽  
pp. A-912
Author(s):  
Ines Gockel ◽  
George Sgourakis ◽  
Mario Domeyer ◽  
Torsten Hansen ◽  
Theodor Junginger ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Early Esophageal Cancer ◽  
Node Metastases

PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 144-144
Author(s):  
Jasper Groen ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Annelijn E Slaman ◽  
Sybren Meijer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Predictive Value ◽  
Neoadjuvant Chemoradiotherapy ◽  
Celiac Trunk ◽  
Pet Ct ◽  
Resection Specimen ◽  
Node Metastases ◽  
18F Fdg

Abstract Background Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy. Methods All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated. Results A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%. Conclusion The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group. Disclosure All authors have declared no conflicts of interest.

Detection of lymph node metastases in esophageal cancer

2011 ◽  
Vol 11 (4) ◽  
pp. 601-612 ◽  
Author(s):  
George Sgourakis ◽  
Ines Gockel ◽  
Orestis Lyros ◽  
Torsten Hansen ◽  
Peter Mildenberger ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Node Metastases

Detection of Lymph Node Metastases in Patients With Prostate Cancer: Comparing Conventional and Digital [18F]-fluorocholine PET-CT Using Histopathology as Reference

2021 ◽  
Author(s):  
Mimmi Bjöersdorff ◽  
Christopher Puterman ◽  
Jenny Oddstig ◽  
Jennifer Amidi ◽  
Sophia Zackrisson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Lymph Node Metastases ◽  
Reconstruction Algorithms ◽  
High Risk Prostate Cancer ◽  
Pet Ct ◽  
Risk Prostate Cancer ◽  
Node Metastases

Abstract Background: Positron emission tomography-computed tomography (PET-CT) can be used to detect and stage metastatic lymph nodes in intermediate to high-risk prostate cancer. Improvements to hardware, such as digital technology, and to software, such as reconstruction algorithms, have recently been made. We compared the capability of detecting regional lymph node metastases using conventional and digital silicon photomultiplier (SiPM)-based PET-CT technology for [18F]-fluorocholine (FCH). Extended pelvic lymph node dissection (ePLND) histopathology was used as the reference method.Methods: Retrospectively, a consecutive series of patients with prostate cancer who had undergone staging with FCH PET-CT before ePLND were included. Images were obtained with either a conventional or a SiPM-based PET-CT and compared. FCH uptake in pelvic lymph nodes beyond the uptake in the mediastinal blood pool was considered to be abnormal.Results: One hundred eighty patients with intermediate or high-risk prostate cancer were examined using a conventional Philips Gemini PET-CT (n = 93) between 2015 and 2017 or a digital GE Discovery MI PET-CT (n = 87) from 2017 to 2018. Images that were obtained using the Philips Gemini PET-CT system showed 19 patients (20%) with suspected lymph node metastases compared with 40 patients (46%) using the GE Discovery MI PET-CT. Sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were 0.30, 0.84, 0.47, and 0.72, respectively, for the Philips Gemini and 0.60, 0.58, 0.30, and 0.83, respectively for GE Discovery MI. Area under the curve (AUC) in a receiver operating characteristics (ROC) analysis was similar between the two PET-CT systems (0.58 and 0.58, P = 0.8).Conclusions: A marked difference in sensitivity and specificity was found for the different PET-CT systems, although similar overall diagnostic performance. This is probably due to differences in both hard- and software, including reconstruction algorithms, and should be considered when new technology is introduced.

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