Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;36(7):5136-5143.
doi: 10.1007/s00464-021-08884-2. Epub 2021 Nov 29.

Long-term outcomes of endoscopic mucosal resection for early-stage esophageal adenocarcinoma

Kesha Oza  1 , Tejasvi Peesay  1 , Benjamin Greenspun  1 , John E Carroll  2 , Shervin Shafa  2 , Jay C Zeck  3 , Nadim G Haddad  2 , Marc Margolis  4 , Puja Gaur Khaitan  5
Affiliations

Long-term outcomes of endoscopic mucosal resection for early-stage esophageal adenocarcinoma

Kesha Oza et al. Surg Endosc. 2022 Jul.

Abstract

Background: With growing application of endoscopic therapy for early-stage esophageal cancer, we sought to review our experience of endoscopic mucosal resections (EMRs). The aim of our study was to understand the natural course of these patients, especially with positive margins.

Methods: A prospectively maintained database of all patients undergoing endoscopic therapies at Georgetown University Hospital for esophageal cancer was used for the analysis between 2010 and 2020.

Results: Of 80 patients in the EMR database, 35 were performed as index cases for esophageal adenocarcinoma. Majority (74.3%) had a pre-treatment ultrasound confirming absence of regional adenopathy. There were no post-EMR bleeding or perforation events requiring re-intervention. Complete R0 resection was achieved in 22/35 (62.9%) after initial EMR. Thirteen patients had positive margins. Of these 13 patients, only 7 patients underwent repeat endoscopic resection, 2 underwent subsequent esophagectomy, 2 received definitive radiation given poor surgical candidacy, and 2 were lost to follow-up. Overall and 5-year survival of all patients undergoing EMR was 67.9 months and 85%, respectively. Subset analysis of the 13 patients with R1 resection demonstrated an overall survival of 49.2 months and 60% 5-year survival vs overall survival of 78.9 months and 93% 5-year survival for R0 resection. At a median follow-up of 60.5 months, cancer recurrence occurred in 3 patients. All of them were successfully managed with repeat EMR.

Conclusions: Endoscopic resections represent a safe and effective treatment for early-stage esophageal cancer. Patients with high-risk features should be counseled to undergo an esophagectomy if they are operable candidates.

Keywords: Early-stage esophageal cancer; Endoscopic resection; Positive margins.

PubMed Disclaimer

References

    1. Pech O, May A, Manner H, Behrens A, Pohl J, Weferling M, Hartmann U, Manner N, Huijsmans J, Gossner L, Rabenstein T, Vieth M, Stolte M et al (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652-660.e651 - DOI
    1. Marino KA, Sullivan JL, Weksler B (2018) Esophagectomy versus endoscopic resection for patients with early-stage esophageal adenocarcinoma: a national cancer database propensity-matched study. J Thorac Cardiovasc Surg 155(5):2211-2218.e2211 - DOI
    1. Ishihara R, Oyama T, Abe S, Takahashi H, Ono H, Fujisaki J, Kaise M, Goda K, Kawada K, Koike T, Takeuchi M, Matsuda R, Hirasawa D et al (2017) Risk of metastasis in adenocarcinoma of the esophagus: a multicenter retrospective study in a Japanese population. J Gastroenterol 52(7):800–808 - DOI
    1. McCarty JC, Parker RK, Vidri RJ, Robinson KA, Lipsitz S, Gangadharan SP, Iyer PG (2020) A retrospective cohort study of endoscopic therapy and esophagectomy for stage 1 esophageal cancer: less is more. Gastrointest Endosc 92(1):23–30 - DOI
    1. Yoshii T, Ohkawa S, Tamai S, Kameda Y (2013) Clinical outcome of endoscopic mucosal resection for esophageal squamous cell cancer invading muscularis mucosa and submucosal layer. Dis Esophagus 26(5):496–502 - DOI

MeSH terms

Supplementary concepts

LinkOut - more resources