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Esophagectomy Following Endoscopic Resection of Submucosal Esophageal Cancer: a Highly Curative Procedure Even with Nodal Metastases

  • 2016 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Despite the increased risk for nodal disease, definitive endoscopic resection is being increasingly offered for lesions invasive into the submucosa based on the success with intramucosal tumors. The aim of this study was to evaluate survival after esophagectomy alone for confirmed submucosal tumors after endoscopic resection.

Methods

Patients from seven centers in the USA who underwent esophagectomy for submucosal tumors removed with endoscopic resection were analyzed. Nodal involvement was correlated with recurrence and survival.

Results

We identified 23 patients with submucosal esophageal adenocarcinoma. Esophagectomy was performed at a median of 2 months (Interquartile range 1–3) after the endoscopic resection. There was no postoperative mortality. Positive nodal disease was seen in 26 % of patients on final pathology. At a median of 37 months (Interquartile range 25–55), 91 % of patients were alive and free of disease. The disease-specific 5-year survival was 88 %. Disease-specific 5-year survival was 67 % in patients with positive nodal metastases and 100 % in those without (p = 0.159).

Conclusions

Esophagectomy is curative in the majority of patients with submucosal tumors even in the presence of nodal metastases. These data serve as a benchmark for comparison when considering extending the indications for therapeutic endoscopic resection for submucosal tumors in the future.

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Acknowledgments

This study was made possible by the generous donation of a grateful patient with Barrett’s esophagus.

Author Contribution

Daniela Molena conceived this study, collected data, performed analysis, and drafted the manuscript. Shanda H. Blackmon, Christy M. Dunst, Wayne L. Hofstetter, Brian E. Louie, Thomas J. Watson, and Steven R. DeMeester participated in the study design and helped coordinate collaboration between institutions. Joshua A. Boys, Karen J. Dickinson, Michal J. Lada and Benedetto Mungo contributed to data collection and analysis. Francisco Schlottmann helped with literature search, data analysis, and writing of the manuscript.

Author information

Authors and Affiliations

  1. Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Daniela Molena & Francisco Schlottmann

  2. Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

    Joshua A. Boys & Steven R. DeMeester

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Shanda H. Blackmon & Karen J. Dickinson

  4. Department of Surgery, The Oregon Clinic, Portland, OR, USA

    Christy M. Dunst

  5. Department of Surgery, MD Anderson, Houston, TX, USA

    Wayne L. Hofstetter

  6. Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA

    Michal J. Lada & Thomas J. Watson

  7. Department of Surgery, Swedish Cancer Institute, Seattle, WA, USA

    Brian E. Louie

  8. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Benedetto Mungo

Authors
  1. Daniela Molena
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Corresponding author

Correspondence to Daniela Molena.

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No financial support was provided for this study

Conflict of Interest

The authors declare that they have no conflict of interest.

Meeting Presentation

Lecture presentation during Digestive Disease Week at the San Diego Convention Center in San Diego, CA, May 21–24, 2016.

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Molena, D., Schlottmann, F., Boys, J.A. et al. Esophagectomy Following Endoscopic Resection of Submucosal Esophageal Cancer: a Highly Curative Procedure Even with Nodal Metastases. J Gastrointest Surg 21, 62–67 (2017). https://doi.org/10.1007/s11605-016-3210-3

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