Comment on “Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma? A Propensity-Matched Analysis”

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Arnulf H. Hölscher ◽  
Elfriede Bollschweiler
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Early Clinical Stage

Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Alexander W. Phillips ◽  
George B. Hanna ◽  
Donald E. Low ◽  
Sheraz R. Markar
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Early Clinical Stage

327 IS LOCAL ENDOSCOPIC RESECTION A VIABLE THERAPEUTIC OPTION FOR EARLY CLINICAL STAGE T1A AND T1B OESOPHAGEAL ADENOCARCINOMA? A PROPENSITY-MATCHED ANALYSIS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Kamarajah ◽  
A Phillips ◽  
G Hanna ◽  
D Low ◽  
S Markar
Keyword(s):  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Nodal Metastasis ◽  
Oesophageal Adenocarcinoma ◽  
Future Research ◽  
Significant Difference ◽  
Node Positive Disease ◽  
Similar Survival ◽  
Early Clinical Stage

Abstract   The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 oesophageal adenocarcinoma is controversial. The aim of this study was to evaluate the outcome of ER versus oesophagectomy in node negative cT1a and cT1b oesophageal adenocarcinoma. Methods Data from the National Cancer Database (2010-2015), was used to identify patients with clinical T1aN0 (n = 2,545) and T1bN0 (n = 1,281) oesophageal adenocarcinoma that received either ER (cT1a, n = 1,581; cT1b, n = 335) or oesophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching (PSM) and Cox multivariable analyses were used to account for treatment selection bias. Results ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b oesophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to oesophagectomy (HR: 0.85, 95% CI: 0.70-1.04, p = 0.1). The corresponding 5-year survival for ER and oesophagectomy were 70% and 74% (p = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66-1.14, p = 0.3). The corresponding 5-year survival for ER and oesophagectomy were 53% vs. 61% (p = 0.3), respectively. Conclusion This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 oesophageal adenocarcinoma. However, 15% of patients with cT1b oesophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from oesophagectomy with lymphadenectomy.

ID: 3524312 OUTCOMES FOR ENDOSCOPIC RESECTION OF T1B ESOPHAGEAL ADENOCARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 93 (6) ◽  
pp. AB292-AB293
Author(s):  
Don C. Codipilly ◽  
Apoorva K. Chandar ◽  
Lovekirat Dhaliwal ◽  
Amitabh Chak ◽  
Kenneth K. Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Meta Analysis

RA08.05: ENDOSCOPIC THERAPY AND SURVEILLANCE VERSUS ESOPHAGECTOMY FOR EARLY ESOPHAGEAL ADENOCARCINOMA: A REVIEW OF EARLY OUTCOMES AND COST ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 38-38
Author(s):  
Piers Boshier ◽  
Andrea Wirsching ◽  
Rajesh Krishnamoorthi ◽  
Michael Larsen ◽  
Shayan Irani ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Esophageal Adenocarcinoma ◽  
Surgical Therapy ◽  
Conflicts Of Interest ◽  
Endoscopic Therapy ◽  
Clinical Stage ◽  
Oncologic Outcomes ◽  
Stricture Formation ◽  
Endoscopic Procedures ◽  
Same Day Discharge

Abstract Background Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (clinical stage T1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early EC. Methods Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015 at a single high-volume center. To ensure comparability between treatment groups only those patients who were deemed medically fit to undergo esophagectomy, regardless of ultimate management, were included. Cost analysis was performed for each patient group and was compared to procedural outcomes. Results Forty-three patients met the inclusion criteria for this study (endoscopic therapy n = 20; esophagectomy n = 23). All patients who underwent endoscopic therapy had clinical stage T1A, whilst 15 patients in the esophagectomy group had T1B disease (P < 0.001). Patient groups were well matched for all other baseline characteristics (P > 0.05). For patients undergoing endoscopic therapy a median of six interventions were performed per patient (range 2–18). Same day discharge was achieved after 98% of all endoscopic procedures with 72% of cases performed under general anesthesia. Endoscopic dilations due to stricture formation were required in five (25%) patients after endoscopic therapy. Esophagectomy was associated with a median hospital stay of 9 (8–13) days and greater procedure specific morbidity compared to endoscopic therapy. Median treatment costs for patients undergoing esophagectomy were significantly greater than that incurred for patients receiving endoscopic therapy only ($53,849, 95%-confidence interval: 50,541–88,784 vs. $22,640, 95%CI: 18,754–46,705, P < 0.001). The minimum cost associated with esophagectomy in the current study was approximately four times greater than for endoscopic therapy ($40,410 vs. $9236). In comparison the maximum cost incurred for surgical and endoscopic therapy were $247,808 and $127,508 respectively. Overall costs were significantly correlated to either number and severity or postoperative complications or number of endoscopic procedures performed (P < 0.002). Conclusion In patients with early EC endoscopic therapy was associated with lower rates of procedure specific morbidity compared to esophagectomy. Despite an increased number of interventions and longer duration of therapy, overall costs were significantly lower in patients undergoing endoscopic therapy when compared to esophagectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Salvage endoscopic resection in patients with esophageal adenocarcinoma after chemoradiotherapy

2018 ◽  
Vol 06 (09) ◽  
pp. E1126-E1129 ◽  
Author(s):  
Irma C. Noordzij ◽  
Wouter L. Curvers ◽  
Clément J. Huysentruyt ◽  
Grard A.P. Nieuwenhuijzen ◽  
Geert-Jan Creemers ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Argon Plasma Coagulation ◽  
Case Series ◽  
Argon Plasma ◽  
Residual Tumor ◽  
Esophageal Resection ◽  
Sustained Remission ◽  
Long Term Prognosis

Abstract Background and study aims For early esophageal adenocarcinoma, endoscopic resection is an accepted curative treatment with an excellent long-term prognosis. Case series from Japan have reported endoscopic resection of residual esophageal squamous cell carcinoma after chemoradiotherapy. This is the first report describing endoscopic resection of residual esophageal adenocarcinoma after chemoradiotherapy. Two patients with advanced esophageal adenocarcinoma had been treated with chemoradiotherapy because comorbidity precluded esophageal resection. When residual tumor was observed endoscopically, complete remission was achieved by salvage endoscopic therapy alone or in combination with argon plasma coagulation (APC). Both patients achieved long-term sustained remission and died of non-tumor-related causes.

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