Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis
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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.
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.
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).
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.
KeywordsEndoscopic mucosal resection Endoscopic submucosal resection Esophagectomy Esophageal neoplasms Propensity score
This work is supported, in part, by Shanghai Science and Technology Commission Foundation key project (14JC140140), Grant from Science and Technology Commission of Shanghai Municipality (No. 15411951602; No. 16401970704), Trans-Century Training Programme Foundation for the Talents by the State Education Commission (NCET-13-0148), Grant from Health and Family Planning Commission of Shanghai Municipality (No. XYQ2011025; No. 2013ZYJB0301). We thank Shannon Wyszomierski, Ph.D. for editing the manuscript.
Compliance with ethical standards
Shengfei Wang, Yangle Huang, Juntao Xie, Lingdun Zhuge, Longlong Shao, Jiaqing Xiang, Yawei Zhang, Yihua Sun, Hong Hu, Sufeng Chen, Toni Lerut, James Luketich, Jie Zhang, and Haiquan Chen have no conflicts of interest or financial ties to disclose.
- 12.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):369–377CrossRefPubMedGoogle Scholar
- 13.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):652–660CrossRefPubMedGoogle Scholar
- 15.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–S43Google Scholar
- 18.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):475–480CrossRefGoogle Scholar
- 20.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.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):282–287CrossRefPubMedGoogle Scholar
- 26.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):255–264CrossRefPubMedGoogle Scholar
- 27.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):556–564CrossRefPubMedGoogle Scholar