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Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma: A North American Perspective

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Data are limited regarding the application of endoscopic submucosal dissection (ESD) in Western countries or for esophageal adenocarcinoma in any part of the world. We sought to review our experience employing ESD in patients with early esophageal cancer at a high volume North American esophageal cancer treatment center.

Methods

A prospectively maintained database of all patients with esophageal cancer treated at the McGill University Health Center was used to identify ESDs performed for adenocarcinoma between 2012 and 2016. Patient demographics, pre-resection tumor characteristics, endoscopic resection technical variables, pathologic results, and short- and long-term outcomes were recorded.

Results

Of 650 patients in the database, 26 underwent 27 procedures. The majority (67%) had pre-treatment EUS. There were no post-ESD bleeding events requiring re-intervention. Perforation occurred in 2/27 (7%), one of which required operative repair. Complete RO resection was achieved in 18/27(67%). Salvage laparoscopic esophagectomy was performed in six patients. At a median follow-up of 18.5 (7–35) months, cancer recurrence occurred in only one patient who subsequently underwent successful repeat ESD.

Conclusions

Although technically challenging, ESD represents a safe and effective treatment of early esophageal adenocarcinoma and has the potential to become a more important tool in management of these early lesions in Western countries.

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References

  1. Pennathur, A., et al., Oesophageal carcinoma. Lancet, 2013. 381(9864): p. 400–12.

    Article  PubMed  Google Scholar 

  2. Kelsen, D.P., et al., Long-term results of RTOG trial 8911 (USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol, 2007. 25(24): p. 3719–25.

    Article  PubMed  Google Scholar 

  3. Abrams, J.A., et al., Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly. Cancer, 2009. 115(21): p. 4924–33.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cools-Lartigue, J., J. Spicer, and L.E. Ferri, Current status of management of malignant disease: current management of esophageal cancer. J Gastrointest Surg, 2015. 19(5): p. 964–72.

    Article  PubMed  Google Scholar 

  5. Birkmeyer, J.D., et al., Hospital volume and surgical mortality in the United States. N Engl J Med, 2002. 346(15): p. 1128–37.

    Article  Google Scholar 

  6. Ra, J., et al., Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol, 2008. 15(6): p. 1577–84.

    Article  PubMed  Google Scholar 

  7. Gopaldas, R.R., et al., Impact of surgeon demographics and technique on outcomes after esophageal resections: a nationwide study. Ann Thorac Surg, 2013. 95(3): p. 1064–9.

    Article  PubMed  Google Scholar 

  8. Dimick, J.B., et al., Specialty training and mortality after esophageal cancer resection. Ann Thorac Surg, 2005. 80(1): p. 282–6.

    Article  PubMed  Google Scholar 

  9. Sudarshan, M. and L. Ferri, A critical review of minimally invasive esophagectomy. Surg Laparosc Endosc Percutan Tech, 2012. 22(4): p. 310–8.

    Article  PubMed  Google Scholar 

  10. Ferri, L.E., et al., The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol, 2006. 13(4): p. 557–64.

    Article  PubMed  Google Scholar 

  11. Rice, T.W., et al., Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer. J Thorac Oncol, 2017. 12(1): p. 36–42.

    Article  Google Scholar 

  12. Rice, T.W., et al., Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. Ann Thorac Surg, 1998. 65(3): p. 787–92.

    Article  CAS  PubMed  Google Scholar 

  13. Siewert, J.R., et al., Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the Western world. Ann Surg, 2001. 234(3): p. 360–7; discussion 368-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Bollschweiler, E., et al., High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy, 2006. 38(2): p. 149–56.

    Article  CAS  PubMed  Google Scholar 

  15. Lee, L., et al., Predicting lymph node metastases in early esophageal adenocarcinoma using a simple scoring system. J Am Coll Surg, 2013. 217(2): p. 191–9.

    Article  PubMed  Google Scholar 

  16. Cho, J.W., et al., Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View. Clin Endosc, 2014. 47(6): p. 523–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sgourakis, G., I. Gockel, and H. Lang, Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol, 2013. 19(9): p. 1424–37.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pech, O., et al., Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology, 2014. 146(3): p. 652–660 e1.

    Article  PubMed  Google Scholar 

  19. Belghazi, K., J. Bergman, and R.E. Pouw, Endoscopic Resection and Radiofrequency Ablation for Early Esophageal Neoplasia. Dig Dis, 2016. 34(5): p. 469–75.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Guo, H.M., et al., Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol, 2014. 20(18): p. 5540–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fujishiro, M., et al., Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol, 2006. 4(6): p. 688–94.

    Article  PubMed  Google Scholar 

  22. Gotoda, T., H. Yamamoto, and R.M. Soetikno, Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol, 2006. 41(10): p. 929–42.

    Article  PubMed  Google Scholar 

  23. Tsou, Y.K., et al., Learning curve for endoscopic submucosal dissection of esophageal neoplasms. Dis Esophagus, 2016. 29(6): p. 544–50.

    Article  PubMed  Google Scholar 

  24. Cho, K.B., W.J. Jeon, and J.J. Kim, Worldwide experiences of endoscopic submucosal dissection: not just Eastern acrobatics. World J Gastroenterol, 2011. 17(21): p. 2611–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yamamoto, H., Endoscopic submucosal dissection—current success and future directions. Nat Rev Gastroenterol Hepatol, 2012. 9(9): p. 519–29.

    Article  PubMed  Google Scholar 

  26. Hirao, M., et al., Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc, 1988. 34(3): p. 264–9.

    Article  CAS  PubMed  Google Scholar 

  27. Bhatt, A., et al., Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol, 2015. 110(6): p. 784–91.

    Article  PubMed  Google Scholar 

  28. Rong, Q.H., et al., Feasibility and safety of endoscopic submucosal dissection of esophageal or gastric carcinomas under general anesthesia. Med Princ Pract, 2013. 22(3): p. 280–4.

    Article  PubMed  Google Scholar 

  29. Committee, A.T., et al., Endoscopic submucosal dissection. Gastrointest Endosc, 2015. 81(6): p. 1311–25.

    Article  Google Scholar 

  30. Nagata, K. and M. Shimizu, Pathological evaluation of gastrointestinal endoscopic submucosal dissection materials based on Japanese guidelines. World J Gastrointest Endosc, 2012. 4(11): p. 489–99.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Park, H.C., et al., Ten-year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center. Korean J Intern Med, 2016. 31(6): p. 1064–1072.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ono, S., et al., Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc, 2009. 70(5): p. 860–6.

    Article  PubMed  Google Scholar 

  33. Neuhaus, H., et al., Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett's esophagus. Endoscopy, 2012. 44(12): p. 1105–13.

    Article  CAS  PubMed  Google Scholar 

  34. Probst, A., et al., Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy, 2015. 47(2): p. 113–21.

    PubMed  Google Scholar 

  35. Hobel, S., et al., Single center experience of endoscopic submucosal dissection (ESD) in early Barrett's adenocarcinoma. Surg Endosc, 2015. 29(6): p. 1591–7.

    Article  CAS  PubMed  Google Scholar 

  36. Chevaux, J.B., et al., Clinical outcome in patients treated with endoscopic submucosal dissection for superficial Barrett's neoplasia. Endoscopy, 2015. 47(2): p. 103–12.

    PubMed  Google Scholar 

  37. Lang, G.D., et al., A single-center experience of endoscopic submucosal dissection performed in a Western setting. Dig Dis Sci, 2015. 60(2): p. 531–6.

    Article  PubMed  Google Scholar 

  38. Yang, D., et al., Endoscopic submucosal dissection for Barrett’s early neoplasia: a multicenter study in the United States. Gastrointest Endosc, 2016.

  39. Terheggen, G., et al., A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut, 2017. 66(5): p. 783–793.

    Article  PubMed  Google Scholar 

  40. Holmes, I., T. Hing, and S. Friedland, Combining endoscopic submucosal dissection and endoscopic mucosal resection to treat neoplasia in Barrett’s esophagus. Surgical Endoscopy, 2016. 30(12): p. 5330–5337.

    Article  PubMed  Google Scholar 

  41. Pech, O., et al., Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy, 2010. 42(06): p. 456–461.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. McGill University, Montreal, QC, Canada

    Philippe Bouchard, Juan-Carlos Molina, Jonathan Cools-Lartigue, Jonathan Spicer, Carmen L. Mueller & Lorenzo E. Ferri

  2. Division of Thoracic and Upper Gastrointestinal Surgery, McGill University, 1650 Cedar Avenue, L8-505, Montreal, QC, H3G 1A4, Canada

    Juan-Carlos Molina, Jonathan Cools-Lartigue, Jonathan Spicer, Carmen L. Mueller & Lorenzo E. Ferri

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  1. Philippe Bouchard
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  2. Juan-Carlos Molina
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  3. Jonathan Cools-Lartigue
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  4. Jonathan Spicer
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  5. Carmen L. Mueller
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  6. Lorenzo E. Ferri
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Correspondence to Lorenzo E. Ferri.

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Bouchard, P., Molina, JC., Cools-Lartigue, J. et al. Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma: A North American Perspective. J Gastrointest Surg 23, 1087–1094 (2019). https://doi.org/10.1007/s11605-018-04093-w

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  • DOI: https://doi.org/10.1007/s11605-018-04093-w

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