Abel Joseph1, Peter V Draganov2, Fauze Maluf-Filho3, Hiroyuki Aihara4, Norio Fukami5, Neil R Sharma6, Amitabh Chak7, Dennis Yang2, Salmaan Jawaid8, John Dumot7, Omar Alaber7, Tiffany Chua5, Rituraj Singh6, Lady Katherine Mejia-Perez9, Ruishen Lyu9, Xuefeng Zhang10, Suneel Kamath11, Sunguk Jang9, Sudish Murthy12, John Vargo9, Amit Bhatt9. 1. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA. 2. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA. 3. Department of Gastroenterology, University of São Paulo, São Paulo, Brazil. 4. Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. 5. Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA. 6. Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA. 7. Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA. 8. Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA. 9. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA. 10. Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA. 11. Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA. 12. Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
BACKGROUND AND AIMS: The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC. METHODS: We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates. RESULTS: Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). CONCLUSIONS: EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
BACKGROUND AND AIMS: The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC. METHODS: We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates. RESULTS: Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). CONCLUSIONS: EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Sanne N van Munster; Eva P D Verheij; Esther A Nieuwenhuis; Johan G J A Offerhaus; Sybren L Meijer; Lodewijk A A Brosens; Bas L A M Weusten; Alaa Alkhalaf; Ed B E Schenk; Erik J Schoon; Wouter L Curvers; Laurelle van Tilburg; Steffi E M van de Ven; Thjon J Tang; Wouter B Nagengast; Martin H M G Houben; Kees C A Seldenrijk; Jacques J G H M Bergman; Arjun D Koch; Roos E Pouw Journal: Endoscopy Date: 2022-01-13 Impact factor: 9.776
Authors: D Chamil Codipilly; Lovekirat Dhaliwal; Meher Oberoi; Parth Gandhi; Michele L Johnson; Ramona M Lansing; W Scott Harmsen; Kenneth K Wang; Prasad G Iyer Journal: Clin Gastroenterol Hepatol Date: 2020-11-18 Impact factor: 11.382