Nasser K. Altorki, Jeffrey L. Port, Paul C. Lee, Yaakov Liss, Danish Meherally, David Jin, Robert J. Korst; CT Surgery, Weill Cornell, New York, NY
Objective: There has been an increasing interest in endoscopic ablative therapy (ET) for intramucosal (T1a) or submucosal (T1b) esophageal carcinoma. We postulated that ET may be more appropriate for T1a rather than T1b tumors.Methods: We retrospectively reviewed the records of all patients who underwent esophagectomy without preoperative therapy for T1 esophageal cancer. A detailed review of all pathology reports was performed to identify relevant pathological criteria including depth of invasion (T1a or T1b), cell type (adeno / squamous), extent of Barrett's esophagus (short segment; SSB and long segment; LSB), nodal status, lymphovascular invasion (LVI), and the presence of multifocal neoplasia: MFN (high grade dysplasia or invasive carcinoma). Overall survival (OS) and disease specific survival (DSS) were determined by the Kaplan-Meier method.
Results: There were 75 consecutive patients (58 men, 17 women). Median age was 68 years. Hospital mortality was 1.3% (1/75). Thirty patients had T1a and forty-five had T1b. Sixty patients had adenocarcinoma . Nodal metastasis were present in 2/30 (6%) T1a and 8/45 (17.5%) T1b tumors. MFN was present in 30% (9/30) T1a tumors and 29% (13/45) T1b tumors. All 10 patients with LVI had T1b tumors. Collectively, 10/30 ( 33.3%) pts with T1a and 26/45 (58%) with T1b had either MFN, LVI or nodal metastases (p=0.038). 47 patients had adenocarcinoma with associated Barrett's esophagus (20 SSB, 27 LSB) . There was a significant difference in the incidence of MFN between patients with SSB and those with LSB (2/20 vs. 13/27 p=0.006) yet, no difference in the incidence of nodal disease (2/20 vs. 2/27). Four patients with squamous carcinoma had nodal metastasis and 5 had MFN. Overall 5-year survival was 78% (T1a: 82% T1b: 69%, p=0.05) Five year DSS was 91% (T1a: 100%, T1b: 85%)
Conclusion: The high incidence of MFN and occult nodal metastasis does not support the use of ET in patients with T1 esophageal cancer regardless of depth of invasion, cell type or extent of BE. ET may be of value in patients in whom surgical risk is considered prohibitive.
Back to Annual Meeting
Back to Program Outline
