Masashi Takeuchi1, Koichi Suda2, Yasuo Hamamoto3, Motohiko Kato4, Shuhei Mayanagi1, Kayo Yoshida5, Kazumasa Fukuda1, Rieko Nakamura1, Norihito Wada1, Hirofumi Kawakubo1, Hiroya Takeuchi6, Naohisa Yahagi3, Yuko Kitagawa2. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Cancer Centre, Keio University School of Medicine, Tokyo, Japan. 3. Cancer Centre, Keio University School of Medicine, Tokyo, Japan. 4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan. 5. Department of Radiology, Keio University School of Medicine, Tokyo, Japan. 6. Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Abstract
BACKGROUND AND AIMS: Active use of endoscopic resection (ER) for cM3-SM2 esophageal cancer may enable sufficient extent of esophageal resection and help determine the need for lymph node dissection based on histopathologic findings. However, ER preceding esophagectomy may have an adverse impact on outcomes. This study was designed to determine the technical feasibility and oncologic safety of diagnostic ER. METHODS: A single-institution retrospective cohort study was performed between July 2008 and June 2014. During this period, 135 consecutive patients with clinical T1a-M3N0M0, T1b-SM1N0M0, and T1b-SM2N0M0 primary esophageal cancer were referred to our division. Eight patients who underwent chemoradiotherapy as primary treatment were excluded because of inadequate pathologic findings. Based on oncologic and physical factors, we categorized the remaining 127 patients into 2 groups: primary esophagectomy (n = 54) and primary ER (n = 73). RESULTS: In all 127 patients, the 3-year overall survival (OS) and disease-free survival (DFS) rates were 95.7% and 87.6%, respectively. No adverse event requiring surgical intervention was observed after ER. Diagnostic ER had no negative impact on surgical outcomes, DFS, and OS after esophagectomy. Fourteen patients (19.2%) of those who received primary ER underwent curative resection, whereas 11 (20.4%) who had pT1a disease, no lymphovascular invasion, and no pathologic lymph node metastasis underwent primary esophagectomy. CONCLUSIONS: Diagnostic ER for cM3-SM2 esophageal cancer with or without subsequent esophagectomy was feasible and safe, not only from a surgical perspective but also an oncologic perspective. Approximately 20% of cM3-SM2N0M0 patients can potentially avoid undergoing additional treatment including esophagectomy using diagnostic ER.
BACKGROUND AND AIMS: Active use of endoscopic resection (ER) for cM3-SM2 esophageal cancer may enable sufficient extent of esophageal resection and help determine the need for lymph node dissection based on histopathologic findings. However, ER preceding esophagectomy may have an adverse impact on outcomes. This study was designed to determine the technical feasibility and oncologic safety of diagnostic ER. METHODS: A single-institution retrospective cohort study was performed between July 2008 and June 2014. During this period, 135 consecutive patients with clinical T1a-M3N0M0, T1b-SM1N0M0, and T1b-SM2N0M0 primary esophageal cancer were referred to our division. Eight patients who underwent chemoradiotherapy as primary treatment were excluded because of inadequate pathologic findings. Based on oncologic and physical factors, we categorized the remaining 127 patients into 2 groups: primary esophagectomy (n = 54) and primary ER (n = 73). RESULTS: In all 127 patients, the 3-year overall survival (OS) and disease-free survival (DFS) rates were 95.7% and 87.6%, respectively. No adverse event requiring surgical intervention was observed after ER. Diagnostic ER had no negative impact on surgical outcomes, DFS, and OS after esophagectomy. Fourteen patients (19.2%) of those who received primary ER underwent curative resection, whereas 11 (20.4%) who had pT1a disease, no lymphovascular invasion, and no pathologic lymph node metastasis underwent primary esophagectomy. CONCLUSIONS: Diagnostic ER for cM3-SM2 esophageal cancer with or without subsequent esophagectomy was feasible and safe, not only from a surgical perspective but also an oncologic perspective. Approximately 20% of cM3-SM2N0M0 patients can potentially avoid undergoing additional treatment including esophagectomy using diagnostic ER.
Authors: Ji Eun Na; Hyuk Lee; Yang Won Min; Byung-Hoon Min; Jun Haeng Lee; Poong-Lyul Rhee; Kyoung-Mee Kim; Jae J Kim Journal: J Cancer Res Clin Oncol Date: 2021-03-05 Impact factor: 4.553
Authors: Nicole G Jawitz; Vignesh Raman; Oliver K Jawitz; Rahul A Shimpi; Richard K Wood; Matthew G Hartwig; Thomas A D'Amico Journal: Ann Surg Date: 2021-03-03 Impact factor: 13.787