Efficacy, Safety, and Long-term Results of Endoscopic Treatment for Early Stage Adenocarcinoma of the Esophagus With Low-risk sm1 Invasion
| Autor: | Oliver Pech, Yvonne Heldmann, Angelika Behrens, Liebwin Gossner, Juergen Pohl, Hendrik Manner, Michael Vieth, Andrea May, Christian Ell, Manfred Stolte |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Esophageal Neoplasms medicine.medical_treatment Argon plasma coagulation Adenocarcinoma Germany Submucosa medicine Humans Esophagus Survival rate Lymph node Aged Aged 80 and over Hepatology business.industry Gastroenterology Endoscopy Middle Aged Esophageal cancer medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Esophagectomy Barrett's esophagus Female business |
| Zdroj: | Clinical Gastroenterology and Hepatology. 11:630-635 |
| ISSN: | 1542-3565 |
| DOI: | 10.1016/j.cgh.2012.12.040 |
| Popis: | Background & Aims Patients with early-stage mucosal (T1a) esophageal adenocarcinoma (EAC) are increasingly treated by endoscopic resection. EACs limited to the upper third of the submucosa (pT1b sm1) could also be treated by endoscopy. We assessed the efficacy, safety, and long-term effects of endoscopic therapy for these patients. Methods We analyzed data from 66 patients with sm1 low-risk lesions (macroscopically polypoid or flat, with a histologic pattern of sm1 invasion, good-to-moderate differentiation [G1/2], and no invasion into lymph vessels or veins) treated by endoscopic therapy at the HSK Hospital Wiesbaden from 1996 through 2010. The efficacy of endoscopic therapy was assessed on the basis of rates of complete endoluminal remission (CER), metachronous neoplasia, lymph node events, and long-term remission (LTR). Safety was assessed on the basis of rate of complications. Results Remissions were assessed in 61 of the 66 patients; 53 of the 61 achieved CER (87%). Of patients with small focal neoplasias ≤2 cm, 97% achieved CER (for those with tumors ≥2 cm, 77%; P = .026). Metachronous neoplasias were observed in 10 of 53 patients (19%; 9 of the 10 underwent repeat endoscopic resection). One patient developed a lymph node metastasis (1.9%). Fifty-one patients achieved LTR (84%); 90% of those with focal lesions ≤2 cm achieved LTR after a mean follow-up period of 47 ± 29.1 months (range, 8–120 months). No tumor-associated deaths were observed, and the estimated 5-year survival rate was 84%. The rate of major complications from endoscopic resection was 1.5%, and no patients died. Conclusions Endoscopic therapy appears to be a good alternative to esophagectomy for patients with pT1b sm1 EAC, on the basis of macroscopic and histologic analyses. The risk of developing lymph node metastases after endoscopic resection for sm1 EAC is lower than the risk of surgery. |
| Databáze: | OpenAIRE |
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