Article (Scientific journals)
Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer
Dermine, S.; Leconte, M.; Leblanc, S. et al.
2019In Therapeutic Advances in Gastroenterology, 12
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Keywords :
Article
Abstract :
[en] Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting. Patients and methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality. Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins (n = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion (n = 3 and 9), adenocarcinoma with deep submucosal invasion (n = 11), poorly differentiated tumor (n = 6) and lymphovascular invasion (n = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status (n = 3) or lymph node metastases (n = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%. Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients. © The Author(s), 2019.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Dermine, S.;  Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Leconte, M.;  Department of Digestive Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Leblanc, S.;  Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Dousset, B.;  Paris Descartes University, Paris, France
Terris, B.;  Paris Descartes University, Paris, France
Berger, A.;  Gastroenterology and Gastrointestinal Endoscopy, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Berger, A.;  Paris Descartes University, Paris, France
Rahmi, G.;  Paris Descartes University, Paris, France
Lepilliez, V.;  Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
Plomteux, O.;  Department of Gastroenterology, Les Cliniques Saint Joseph, Liège, Belgium
Leclercq, Philippe ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Coriat, R.;  Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Chaussade, S.;  Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Prat, F.;  Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Barret, M.;  Department of Gastroenterology and Digestive Oncology, Cochin Hospital, 27, Rue du Faubourg St Jacques, Paris, 75014, France
More authors (5 more) Less
Language :
English
Title :
Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer
Publication date :
2019
Journal title :
Therapeutic Advances in Gastroenterology
ISSN :
1756-283X
eISSN :
1756-2848
Publisher :
SAGE Publications, United Kingdom
Volume :
12
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 02 July 2021

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