Endoscopic and surgical management of early esophageal cancer: Current evidence and evolving oncologic strategies

Table 4 Risk stratification and treatment recommendations for early esophageal cancer

Risk category	Tumor characteristics	Lymph node risk	Recommended treatment
Ultra-low risk	T1a (M1-M2), well differentiated, no LVI	Minimal (< 1%)	EMR or ESD
Low risk	T1a (M3), small lesions, no LVI	Low (approximately 1%-5%)	ESD preferred
Intermediate risk	T1b (SM1), no LVI, favorable histology	Moderate (approximately 5%-15%)	ESD ± additional therapy or surgery
High risk	T1b (deep SM), LVI+, poor differentiation	High (> 20%)	Surgical resection ± chemoradiotherapy

ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; LVI: Lymphovascular invasion.