Langzeitergebnisse der kurativen Endoskopischen Resektion von Barrettfrühkarzinomen mit Niedrigrisiko (Low Risk)-Submukosainfiltration

Background: Endoscopic therapy (ET) has become a less risky alternative to open surgery in mucosal Barrett's cancer (BC) because of the very low risk of lymph node (LN) metastasis. Recently published surgical series demonstrated that even in case of minimal submucosal invasion of BC, the risk for LN metastasis is very low. In consequence, also these pt might be eligible for curative ET. The aim of this study was to prospectively evaluate efficacy and safety of endoscopic resection (ER) in these pt.

Methods: From 09/96 to 09/03, the suspicion or definite diagnosis of submucosal BC was made in 80 pt referred to our department. Of those, 21 pt (20 male (95.2%); mean age 62±9yrs, range 47–78) fulfilled the definition of “low risk“ submucosal cancer: Invasion of the upper submucosal third (sm1), absence of infiltration into lymphatic (nor blood) vessels, histological grade G1/2, and macroscopic type I/II. ET was carried out using ER with the suck-and-cut technique with/without additive ablation of non-neoplastic remnants of Barrett's esophagus.

Results: One of the 21 pt was referred to surgery directly after detection of sm1 invasion at the beginning of the study. One pt died (not tumour-related) before completion of ET. Using definitive ET, complete remission (CR) was achieved in 18/19 pt (95%) after a mean of 5.3 months (range 1–18) and a mean of 2.9 resections (range 1–9). Only one minor complication (bleeding without drop of haemoglobin >2g/dl) occurred (5% of pt). During a mean follow-up (FU) of 62 months (range 45–89), recurrent or metachronous carcinomas were found in 5 pt (28%). Repeat ET was carried out successfully using ER (4 pt) and APC (1 pt). In one of the 19 pt (5%), tumour-freedom had not been achieved after a total of 2 ER. This patient died of a heart-attack before surgery could be performed. The calculated 5-year survival rate of all 21 pt was 66%. No tumour-related death occured.

Conclusions: As in mucosal Barrett's cancer, ER is associated with favourable outcomes even in case of “low risk“ submucosal BC. Further and larger clinical trials are required, before a general recommendation for ER as the treatment of choice in “low risk“ submucosal Barrett's cancer can be given.

Keywords: Endoskopische Resektion, Langzeitergebnisse, Barrettfrühkarzinom, Submukosainfiltration