cT2N0 esophageal cancer: EMR found safe, potentially beneficial

  • Nelson DB & al.
  • Dis Esophagus
  • 19 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Endoscopic mucosal resection (EMR) was safe in patients with endoscopic ultrasound-staged cT2N0 esophageal cancer and eliminated all signs of disease in some, with no added complications.

Why this matters

  • Patients with cT2N0 esophageal cancer diagnosed by endoscopic ultrasound often undergo surgery only to be found to have superficial disease. EMR could spare some from surgical morbidity and mortality.

Study design

  • Single-center, retrospective analysis of 75 patients with cT2N0 with predicted low risk of lymph node metastasis. 30 underwent an EMR attempt, 45 underwent trimodality therapy or esophagectomy alone.
  • Funding: Mason Family, anonymous donors, and departmental support.

Key results

  • Patients who underwent EMR were older (71 vs 63 years; P<.001 had fewer gastroesophageal junction tumors vs smaller cm p and were less fludeoxyglucose>
  • There were no perforations or immediate complications in the EMR group.
  • 17/30 had complete clearance of disease following EMR. In 4 of these 17 patients, there was lymphovascular invasion. There were no recurrences or cancer-related deaths in this group.
  • No variables were found to predict whether or not EMR would clear all known disease.

Limitations

  • Retrospective design.
  • Single institution.
  • Small sample size.

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