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Outcomes of endoscopic resection for high-grade dysplasia and esophageal cancer

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Abstract

Background

Endoscopic resection (ER) is an important advance in the management of esophageal tumors. It has been used successfully for superficial esophageal cancer and high-grade dysplasia (HGD) arising out of Barrett epithelium.

Methods

From a single institution within the Department of Surgery, patients who underwent ER for esophageal tumors between December 2001 and January 2012 were evaluated. Demographic, clinical, and pathologic variables were collected and reviewed.

Results

We identified 81 patients who underwent ER for esophageal lesions. Median patient age was 69 years, and the median follow-up was 3.25 years. In patients with HGD, at the time of last endoscopy, the complete eradication rate of HGD was 84 % and cancer-specific survival was 100 %. During surveillance, one patient developed an invasive carcinoma that required endoscopic therapy. Patients with T1a and negative deep margins on ER had a recurrence-free and cancer-specific survival of 100 %. There were seven patients with T1b and negative margins on ER. Three patients underwent esophagectomy; final pathology revealed no residual malignancy or lymph node metastasis. Two patients had definitive chemoradiation, and two patients were observed. To date, there has been no cancer recurrence. In all patients who underwent ER, there was one episode of bleeding that required endoscopic treatment and admission for observation.

Conclusions

ER can be performed safely and can adequately stage and often treat patients with HGD and superficial cancers. Patients with HGD and T1a disease with negative margins are cured with ER alone. Observation and surveillance may be an option for select patients with low-risk, early submucosal disease (T1b) and negative margins.

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Disclosures

Dr. Nurkin is a consultant for Bitwise Analytics Inc., an IT software development company. Dr. Hochwald is a consultant for Ethicon Endosurgery. Dr. Khushalani is on an advisory board for Genentech, Elekta and Prometheus, on the speakers’ bureau for Prometheus, and obtained grant funding (for clinical trials) from the National Comprehensive Cancer Network through research funds from Roche, Allos, and Pfizer and from Merck, Pfizer (for investigator-initiated clinical trials).

Conflict of interest

Drs. LeVea, Nava, Bain, Nwogu, Yendamuri, and Wilding and Adrienne Groman have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA

    Steven J. Nurkin, Hector R. Nava, Andrew J. Bain & Steven N. Hochwald

  2. Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA

    Sai Yendamuri & Chumy E. Nwogu

  3. Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Charles M. LeVea

  4. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA

    Adrienne Groman & Gregory Wilding

  5. Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA

    Nikhil I. Khushalani

Authors
  1. Steven J. Nurkin
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  2. Hector R. Nava
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  3. Sai Yendamuri
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  4. Charles M. LeVea
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  5. Chumy E. Nwogu
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  6. Adrienne Groman
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  7. Gregory Wilding
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  8. Andrew J. Bain
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  9. Steven N. Hochwald
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  10. Nikhil I. Khushalani
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Correspondence to Steven J. Nurkin.

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Nurkin, S.J., Nava, H.R., Yendamuri, S. et al. Outcomes of endoscopic resection for high-grade dysplasia and esophageal cancer. Surg Endosc 28, 1090–1095 (2014). https://doi.org/10.1007/s00464-013-3270-3

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  • DOI: https://doi.org/10.1007/s00464-013-3270-3

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