Skip to main content
main-content
Erschienen in: Surgical Endoscopy 3/2018

15.09.2017

Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis

verfasst von: Shengfei Wang, Yangle Huang, Juntao Xie, Lingdun Zhuge, Longlong Shao, Jiaqing Xiang, Yawei Zhang, Yihua Sun, Hong Hu, Sufeng Chen, Toni Lerut, James D. Luketich, Jie Zhang, Haiquan Chen

Erschienen in: Surgical Endoscopy | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Although endoscopic resection (ER) may be sufficient treatment for early-stage esophageal cancer, additional treatment is recommended when there is a high risk of cancer recurrence. It is unclear whether delaying esophagectomy by performing and assessing the success of ER affects outcomes as compared with immediate esophagectomy without ER. Additionally, long-term survival after sequential ER and esophagectomy required further investigation.

Methods

Between 2011 and 2015, 48 patients with stage T1 esophageal cancer underwent esophagectomy after ER with curative intent at our institution. Two-to-one propensity score methods were used to identify 96 matched-control patients who were treated with esophagectomy only using baseline patient, tumor characteristics and surgical approach. Time from initial evaluation to esophagectomy, relapse-free survival, overall survival, and postoperative complications were compared between the propensity-matched groups.

Results

In the ER + esophagectomy group, the time from initial evaluation to esophagectomy was significantly longer than in the esophagectomy only group (114 vs. 8 days, p < 0.001). The incidence of dense adhesion (p = 0.347), operative time (p = 0.867), postoperative surgical complications (p = 0.966), and postoperative length of hospital stay (p = 0.125) were not significantly different between the groups. Moreover, recurrence-free survival and overall survival were also similar between the two groups (p = 0.411 and p = 0.817, respectively).

Conclusions

Treatment of stage T1 esophageal cancer with ER prior to esophagectomy did not increase the difficulty of performing esophagectomy or the incidence of postoperative complications and did not affect survival after esophagectomy. These results suggest that ER can be recommended for patients with stage T1 cancer even if esophagectomy is warranted eventually.
Literatur
1.
Zurück zum Zitat Wang GQ, Jiao GG, Chang FB, Fang WH, Song JX, Lu N, Lin DM, Xie YQ, Yang L (2004) Long-term results of operation for 420 patients with early squamous cell esophageal carcinoma discovered by screening. Ann Thorac Surg 77(5):1740–1744 CrossRefPubMed Wang GQ, Jiao GG, Chang FB, Fang WH, Song JX, Lu N, Lin DM, Xie YQ, Yang L (2004) Long-term results of operation for 420 patients with early squamous cell esophageal carcinoma discovered by screening. Ann Thorac Surg 77(5):1740–1744 CrossRefPubMed
2.
Zurück zum Zitat Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Holscher AH (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254(1):67–72 CrossRefPubMed Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Holscher AH (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254(1):67–72 CrossRefPubMed
3.
Zurück zum Zitat Kim DU, Lee JH, Min BH, Shim SG, Chang DK, Kim YH, Rhee PL, Kim JJ, Rhee JC, Kim KM, Shim YM (2008) Risk factors of lymph node metastasis in T1 esophageal squamous cell carcinoma. J Gastroenterol Hepatol 23(4):619–625 CrossRefPubMed Kim DU, Lee JH, Min BH, Shim SG, Chang DK, Kim YH, Rhee PL, Kim JJ, Rhee JC, Kim KM, Shim YM (2008) Risk factors of lymph node metastasis in T1 esophageal squamous cell carcinoma. J Gastroenterol Hepatol 23(4):619–625 CrossRefPubMed
4.
Zurück zum Zitat Spechler SJ (2015) Dysplasia in Barrett’s esophagus: limitations of current management strategies. Am J Gastroenterol 100(4):927–935 CrossRef Spechler SJ (2015) Dysplasia in Barrett’s esophagus: limitations of current management strategies. Am J Gastroenterol 100(4):927–935 CrossRef
5.
Zurück zum Zitat Pech O, May A, Gossner L, Rabenstein T, Manner H, Huijsmans J, Vieth M, Stolte M, Berres M, Ell C (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39(1):30–35 CrossRefPubMed Pech O, May A, Gossner L, Rabenstein T, Manner H, Huijsmans J, Vieth M, Stolte M, Berres M, Ell C (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39(1):30–35 CrossRefPubMed
6.
Zurück zum Zitat Das A, Singh V, Fleischer DE, Sharma VK (2008) A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data. Am J Gastroenterol 103(6):1340–1345 CrossRefPubMed Das A, Singh V, Fleischer DE, Sharma VK (2008) A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data. Am J Gastroenterol 103(6):1340–1345 CrossRefPubMed
7.
Zurück zum Zitat Nealis TB, Washington K, Keswani RN (2011) Endoscopic therapy of esophageal premalignancy and early malignancy. J Natl Compr Cancer Netw: JNCCN 9(8):890–899 CrossRef Nealis TB, Washington K, Keswani RN (2011) Endoscopic therapy of esophageal premalignancy and early malignancy. J Natl Compr Cancer Netw: JNCCN 9(8):890–899 CrossRef
8.
Zurück zum Zitat Choi JY, Park YS, Jung HY, Ahn JY, Kim MY, Lee JH, Choi KS, Kim do H, Choi KD, Song HJ, Lee GH, Cho KJ, Kim JH (2011) Feasibility of endoscopic resection in superficial esophageal squamous carcinoma. Gastrointest Endosc 73(5):881–889 CrossRefPubMed Choi JY, Park YS, Jung HY, Ahn JY, Kim MY, Lee JH, Choi KS, Kim do H, Choi KD, Song HJ, Lee GH, Cho KJ, Kim JH (2011) Feasibility of endoscopic resection in superficial esophageal squamous carcinoma. Gastrointest Endosc 73(5):881–889 CrossRefPubMed
9.
Zurück zum Zitat Park JS, Youn YH, Park JJ, Kim JH, Park H (2016) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc 49(2):168–175 CrossRefPubMedPubMedCentral Park JS, Youn YH, Park JJ, Kim JH, Park H (2016) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal squamous neoplasms. Clin Endosc 49(2):168–175 CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Qin X, He S, Zhang Y, Xue L, Lu N, Wang G (2014) Diagnosis and staging of superficial esophageal precursor based on pre-endoscopic resection system comparable to endoscopic resection. BMC Cancer 14:774 CrossRefPubMedPubMedCentral Qin X, He S, Zhang Y, Xue L, Lu N, Wang G (2014) Diagnosis and staging of superficial esophageal precursor based on pre-endoscopic resection system comparable to endoscopic resection. BMC Cancer 14:774 CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ (2014) Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst 106(7):dju133 CrossRefPubMed Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ (2014) Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst 106(7):dju133 CrossRefPubMed
12.
Zurück zum Zitat Davison JM, Landau MS, Luketich JD, McGrath KM, Foxwell TJ, Landsittel DP, Gibson MK, Nason KS et al (2016) A model based on pathologic features of superficial esophageal adenocarcinoma complements clinical node staging in determining risk of metastasis to lymph nodes. Clin Gastroenterol Hepatol 14(3):369–377 CrossRefPubMed Davison JM, Landau MS, Luketich JD, McGrath KM, Foxwell TJ, Landsittel DP, Gibson MK, Nason KS et al (2016) A model based on pathologic features of superficial esophageal adenocarcinoma complements clinical node staging in determining risk of metastasis to lymph nodes. Clin Gastroenterol Hepatol 14(3):369–377 CrossRefPubMed
13.
Zurück zum Zitat 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, Ell C et al (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652–660 CrossRefPubMed 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, Ell C et al (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652–660 CrossRefPubMed
14.
Zurück zum Zitat Gertler R, Stein HJ, Schuster T, Rondak IC, Höfler H, Feith M et al (2014) Prevalence and topography of lymph node metastases in early esophageal and gastric cancer. Ann Surg 259(1):96–101 CrossRefPubMed Gertler R, Stein HJ, Schuster T, Rondak IC, Höfler H, Feith M et al (2014) Prevalence and topography of lymph node metastases in early esophageal and gastric cancer. Ann Surg 259(1):96–101 CrossRefPubMed
15.
Zurück zum Zitat Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58 (6 Suppl): S3–S43 Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58 (6 Suppl): S3–S43
16.
Zurück zum Zitat Van Westreenen HL, Westerterp M, Bossuyt PM, Pruim J, Sloof GW, van Lanschot JJ, Groen H, Plukker JT (2004) Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22(18):3805–3812 CrossRefPubMed Van Westreenen HL, Westerterp M, Bossuyt PM, Pruim J, Sloof GW, van Lanschot JJ, Groen H, Plukker JT (2004) Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22(18):3805–3812 CrossRefPubMed
17.
Zurück zum Zitat Lightdale CJ, Kulkarni KG (2005) Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 23(20):4483–4489 CrossRefPubMed Lightdale CJ, Kulkarni KG (2005) Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 23(20):4483–4489 CrossRefPubMed
18.
Zurück zum Zitat Eguchi T, Nakanishi Y, Shimoda T, Iwasaki M, Igaki H, Tachimori Y, Kato H, Yamaguchi H, Saito D, Umemura S (2006) Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Modern Pathol 19(3):475–480 CrossRef Eguchi T, Nakanishi Y, Shimoda T, Iwasaki M, Igaki H, Tachimori Y, Kato H, Yamaguchi H, Saito D, Umemura S (2006) Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Modern Pathol 19(3):475–480 CrossRef
19.
Zurück zum Zitat Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoleon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T (2007) Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 39(1):24–29 CrossRefPubMed Ciocirlan M, Lapalus MG, Hervieu V, Souquet JC, Napoleon B, Scoazec JY, Lefort C, Saurin JC, Ponchon T (2007) Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 39(1):24–29 CrossRefPubMed
20.
Zurück zum Zitat NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. http://​www.​nccn.​org. Version 1.2017. Updated March 21, 2017. Accessed 1 June 2017 NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. http://​www.​nccn.​org. Version 1.2017. Updated March 21, 2017. Accessed 1 June 2017
21.
Zurück zum Zitat Tomita N, Matsumoto T, Hayashi T, Arakawa A, Sonoue H, Kajiyama Y, Tsurumaru M (2008) Lymphatic invasion according to D2-40 immunostaining is a strong predictor of nodal metastasis in superficial squamous cell carcinoma of the esophagus: algorithm for risk of nodal metastasis based on lymphatic invasion. Pathol Int 58(5):282–287 CrossRefPubMed Tomita N, Matsumoto T, Hayashi T, Arakawa A, Sonoue H, Kajiyama Y, Tsurumaru M (2008) Lymphatic invasion according to D2-40 immunostaining is a strong predictor of nodal metastasis in superficial squamous cell carcinoma of the esophagus: algorithm for risk of nodal metastasis based on lymphatic invasion. Pathol Int 58(5):282–287 CrossRefPubMed
22.
Zurück zum Zitat Sgourakis G, Gockel I, Lang H (2013) Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol 19(9):1424–1437 CrossRefPubMedPubMedCentral Sgourakis G, Gockel I, Lang H (2013) Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol 19(9):1424–1437 CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Holscher AH (2007) Endoscopic mucosal resection for early squamous-cell cancer of the esophagus–a dangerous game or standard treatment? Endoscopy 39(1):77–79 PubMed Holscher AH (2007) Endoscopic mucosal resection for early squamous-cell cancer of the esophagus–a dangerous game or standard treatment? Endoscopy 39(1):77–79 PubMed
24.
Zurück zum Zitat Badreddine RJ, Prasad GA, Lewis JT, Lutzke LS, Borkenhagen LS, Dunagan KT, Wang KK (2010) Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma. Clin Gastroenterol Hepatol 8(3):248–253 CrossRefPubMed Badreddine RJ, Prasad GA, Lewis JT, Lutzke LS, Borkenhagen LS, Dunagan KT, Wang KK (2010) Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma. Clin Gastroenterol Hepatol 8(3):248–253 CrossRefPubMed
25.
Zurück zum Zitat Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70(5):860–866 CrossRefPubMed Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70(5):860–866 CrossRefPubMed
26.
Zurück zum Zitat Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, Kagaya H, Shimizu Y, Hokari K, Tsukagoshi H, Shinomura Y, Fujita M (2010) Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 72(2):255–264 CrossRefPubMed Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, Kagaya H, Shimizu Y, Hokari K, Tsukagoshi H, Shinomura Y, Fujita M (2010) Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc 72(2):255–264 CrossRefPubMed
27.
Zurück zum Zitat Okada K, Tsuchida T, Ishiyama A, Taniguchi T, Suzuki S, Horiuchi Y, Matsuo Y, Yoshizawa N, Suganuma T, Omae M, Kubota M, Hirasawa T, Yamamoto Y, Inamori M, Yamamoto N, Nakajima A (2012) Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas. Endoscopy 44(6):556–564 CrossRefPubMed Okada K, Tsuchida T, Ishiyama A, Taniguchi T, Suzuki S, Horiuchi Y, Matsuo Y, Yoshizawa N, Suganuma T, Omae M, Kubota M, Hirasawa T, Yamamoto Y, Inamori M, Yamamoto N, Nakajima A (2012) Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas. Endoscopy 44(6):556–564 CrossRefPubMed
28.
Zurück zum Zitat Tang B, Bai JY, Zhao XY, Fan CQ, Yang X, Deng L, Yang SM, Yu J (2015) Endoscopic submucosal dissection for superficial esophageal cancer with near-circumferential lesions: our experience with 40 patients. Surg Endosc 29(8):2141–2148 CrossRefPubMed Tang B, Bai JY, Zhao XY, Fan CQ, Yang X, Deng L, Yang SM, Yu J (2015) Endoscopic submucosal dissection for superficial esophageal cancer with near-circumferential lesions: our experience with 40 patients. Surg Endosc 29(8):2141–2148 CrossRefPubMed
Metadaten
Titel
Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis
verfasst von
Shengfei Wang
Yangle Huang
Juntao Xie
Lingdun Zhuge
Longlong Shao
Jiaqing Xiang
Yawei Zhang
Yihua Sun
Hong Hu
Sufeng Chen
Toni Lerut
James D. Luketich
Jie Zhang
Haiquan Chen
Publikationsdatum
15.09.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5830-4