Outcomes after radical endoscopic resection of high-risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study.

Abstract

Introduction Post-endoscopic resection (ER) management of high-risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastases (LNM) We aimed to assess outcomes following radical ER for high-risk T1 EAC. Methods We identified patients who underwent radical ER (tumor-negative deep margin) of high-risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008-2019 across 11 international centers. Results In total, 106 patients (86 men, 70 ±11 years) were included. Of these, 26 patients (64 ±11 yrs) underwent additional surgery, with residual T1 EAC in 5 (19%) and LNM in 2 (8%) cases. After median 47 (IQR 32-79) months follow-up, 2/26 (8%) developed LNM/distant metastasis (DM), with 1 (4%) EAC-related death. There was 1/26 (4%) unrelated death and 4/26 (15%) were lost to follow-up. Eighty patients (71 ±9 yrs) entered endoscopic surveillance. Over 46 (IQR 25-59) months follow-up, 5/80 (6%) developed LNM/DM, with 4/80 (5%) EAC-related deaths. There were 15/80 (19%) unrelated deaths, and 10/80 (13%) were lost to follow-up. Overall rates during follow-up were 6% (95% CI 2-12) for LNM, 7% (95% CI 3-13) for LNM/DM, 5% (95% CI 2-11) for EAC-related mortality, and 20% (95% CI 13-29) for overall mortality. Conclusion Our findings present low rates of LNM after radical ER of high-risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.