Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4698
Peer-review started: August 1, 2018
First decision: August 24, 2018
Revised: September 29, 2018
Accepted: October 16, 2018
Article in press: October 16, 2018
Published online: November 7, 2018
To assess clinical outcomes for submucosal (T1b) oesophageal adenocarcinoma (OAC) patients managed with either surgery or endoscopic eradication therapy.
Patients found to have T1b OAC following endoscopic resection between January 2008 to February 2016 at University College London Hospital were retrospectively analysed. Patients were split into low-risk and high-risk groups according to established histopathological criteria and were then further categorised according to whether they underwent surgical resection or conservative management. Study outcomes include the presence of lymph-node metastases, disease-specific mortality and overall survival.
A total of 60 patients were included; 22 patients were surgically managed (1 low-risk and 21 high-risk patients) whilst 38 patients were treated conservatively (12 low-risk and 26 high-risk). Overall, lymph node metastases (LNM) were detected in 10 patients (17%); six of these patients had undergone conservative management and LNM were detected at a median of 4 mo after endoscopic mucosal resection (EMR). All LNM occurred in patients with high-risk lesions and this represented 21% of the total high-risk lesions. Importantly, there was no statistically significant difference in tumor-related deaths between those treated surgically or conservatively (P = 0.636) and disease-specific survival time was also comparable between the two treatment strategies (P = 0.376).
T1b tumours without histopathological high-risk markers of LNM can be treated endoscopically with good out-comes. In selected patients, endoscopic therapy may be appropriate for high-risk lesions.
Core tip: Our retrospective cohort data supports previously published work demonstrating that endoscopic therapy is a safe and effective option for T1b oesophageal adenocarcinoma without markers of high-risk for lymph-node metastasis. Furthermore, our work suggests that endoscopic therapy is a viable alternative to surgery in selected patients with high-risk lesions (particularly those with poor performance status) and highlights the need for further work exploring whether endoscopic therapy could be a viable option for all submucosal lesions.