Favorable effect of endoscopic reassessment of clinically staged T2 esophageal adenocarcinoma: a multicenter prospective cohort study

Steffi E. M. van de Ven; Manon C. W. Spaander; Roos E. Pouw; Thjon J. Tang; Martin H. M. G. Houben; Erik J. Schoon; Pieter J. F. de Jonge; Marco J. Bruno; Arjun D. Koch

doi:10.1055/a-1380-8899

Endoscopy, Table of Contents

Endoscopy 2022; 54(02): 163-169
DOI: 10.1055/a-1380-8899

Innovations and brief communications

Favorable effect of endoscopic reassessment of clinically staged T2 esophageal adenocarcinoma: a multicenter prospective cohort study

Steffi E. M. van de Ven

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

,

Manon C. W. Spaander

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

,

Roos E. Pouw

²Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands

,

Thjon J. Tang

³Department of Gastroenterology and Hepatology, Ijsselland Hospital, Capelle aan den Ijssel, The Netherlands

,

Martin H. M. G. Houben

⁴Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands

,

Erik J. Schoon

⁵Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands

,

Pieter J. F. de Jonge

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

,

Marco J. Bruno

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

,

Arjun D. Koch

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

› Author Affiliations

Abstract

Background Clinical tumor stage of esophageal adenocarcinoma (EAC) is determined by endoscopic ultrasound and/or computed tomography scan, which have low accuracy for stages T1 and T2, potentially leading to overtreatment. We aimed to assess the proportion of cT2 EACs downstaged to cT1 after endoscopic reassessment (ERA) by an experienced interventional endoscopist.

Methods We performed a prospective multicenter cohort study. Patients with cT2N0M0 EAC were included and underwent ERA. The primary outcome was proportion of cT2 EACs downstaged to cT1 after ERA.

Results 15/25 included patients (60 %) were downstaged from cT2 to cT1 EAC after ERA and underwent attempted endoscopic resection. Endoscopic resection was aborted in 3/15 patients because of tumor invasion into the muscle layer; all three underwent successful surgical resection. Endoscopic resection was successful in 12/15 patients (80 %), all of whom had pT1 tumors. Overall, 10/25 (40 %) were treated with endoscopic resection alone.

Conclusions ERA downstaged about half of the cT2 tumors to cT1, rendering them suitable for endoscopic resection. ERA had substantial clinical impact on therapeutic management, preventing overtreatment in 40 % of patients.

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References

References
1 Bahin FF, Jayanna M, Hourigan LF. et al. Long-term outcomes of a primary complete endoscopic resection strategy for short-segment Barrett’s esophagus with high-grade dysplasia and/or early esophageal adenocarcinoma. Gastrointest Endosc 2016; 83: 68-77
2 Fitzgerald RC, di Pietro M, Ragunath K. et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7-42
3 Choi J, Kim SG, Kim JS. et al. Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer. Surg Endosc 2010; 24: 1380-1386
4 O’Farrell NJ, Malik V, Donohoe CL. et al. Appraisal of staging endoscopic ultrasonography in a modern high-volume esophageal program. World J Surg 2013; 37: 1666-1672
5 Pech O, Gunter E, Dusemund F. et al. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy 2010; 42: 456-461
6 Gotink AW, Spaander MCW, Doukas M. et al. Exploring diagnostic and therapeutic implications of endoscopic mucosal resection in EUS-staged T2 esophageal adenocarcinoma. Endoscopy 2017; 49: 941-948
7 Hamai Y, Hihara J, Taomoto J. et al. Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer. Dis Esophagus 2015; 28: 358-364
8 van Hagen P, Hulshof MC, van Lanschot JJ. et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-2084
9 Crabtree TD, Kosinski AS, Puri V. et al. Evaluation of the reliability of clinical staging of T2 N0 esophageal cancer: a review of the Society of Thoracic Surgeons database. Ann Thorac Surg 2013; 96: 382-390
10 May A, Gunter E, Roth F. et al. Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial. Gut 2004; 53: 634-640
11 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
12 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
13 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111: 30-50
14 Brinkmann S, Noordman BJ, Holscher AH. et al. External validation of pretreatment pathological tumor extent in patients with neoadjuvant chemoradiotherapy plus surgery for esophageal cancer. Ann Surg Oncol 2020; 27: 1250-1258
15 Ajani JA, D’Amico TA, Bentrem DJ. et al. Esophageal and esophagogastric junction cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17: 855-883
16 Rice TW, Mason DP, Murthy SC. et al. T2N0M0 esophageal cancer. J Thorac Cardiovasc Surg 2007; 133: 317-324
17 Moss A, Bourke MJ, Hourigan LF. et al. Endoscopic resection for Barrett’s high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol 2010; 105: 1276-1283
18 Nelson DB, Mitchell KG, Weston BR. et al. Should endoscopic mucosal resection be attempted for cT2N0 esophageal cancer?. Dis Esophagus 2019; 32: 1-6