Original article
General thoracic
Esophagectomy for T1 Esophageal Cancer: Outcomes in 100 Patients and Implications for Endoscopic Therapy

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.
https://doi.org/10.1016/j.athoracsur.2008.12.060Get rights and content

Objectives

Esophagectomy is the standard treatment for T1 esophageal cancer (EC). Interest in endoscopic therapies, particularly for T1 EC, is increasing. We evaluated the long-term outcomes after esophagectomy and examined the pathologic features of T1 cancer to determine the suitability for potential endoscopic therapy.

Methods

We reviewed the outcomes of esophagectomy in 100 consecutive patients with T1 EC. The primary end points studied were overall survival (OS) and disease-free survival (DFS). In addition to detailed pathology review, we evaluated prognostic variables associated with survival.

Results

Esophagectomy was performed in 100 patients (79 men, 21 women; median age, 68 years) for T1 EC, comprising adenocarcinoma, 91; squamous, 9; intramucosal (T1a), 29; and submucosal (T1b), 71. The 30-day mortality was 0%. Resection margins were microscopically negative in 99 patients (99%). N1 disease was present in 21 (T1a, 2 of 29 [7%]; T1b, 19 of 71 [27%]), associated high-grade dysplasia in 64 (64%), and angiolymphatic invasion in 19 (19%). At a median follow-up of 66 months, estimated 5-year OS was 62% and 3-year DFS was 80% for all patients (including N1). Nodal status and tumor size were significantly associated with OS and DFS, respectively.

Conclusions

Esophagectomy can be performed safely in patients with T1 EC with good long-term results. Many patients with T1 EC have several risk factors that may preclude adequate treatment with endoscopic therapy. Further prospective studies are required to evaluate endoscopic therapies. Esophagectomy should continue to remain the standard treatment in patients with T1 EC.

Section snippets

Materials and Methods

We reviewed our experience retrospectively with 100 consecutive, pathologically proven T1 esophageal tumors treated with esophagectomy at the University of Pittsburgh Medical Center from 1995 to 2004. Patients who underwent neoadjuvant therapy or who had distant metastases were excluded. This study was approved by the University of Pittsburgh Institutional Review Board. Because this was a retrospective study, individual consent was waived.

Patient Characteristics

Esophagectomy was performed in 100 consecutive patients (79 men, 21 women) who were a median age of 68 years. The histology was adenocarcinoma in 91 (91%) and squamous cell carcinoma in 9 (9%). The tumor was intramucosal (T1a) in 29 patients and submucosal (T1b) in 71. The patient characteristics are summarized in Table 1. HGD was the preoperative diagnosis in 12 patients; of these, the final pathology specimen showed T1a (intramucosal) neoplasms in 4 patients, and submucosal lesions in 8

Comment

The incidence of esophageal cancer has increased dramatically during the past 3 decades [1]. Early-stage adenocarcinoma is more frequently encountered in clinical practice [2, 8]. In light of emerging endoscopic therapies for early-stage cancers, we have analyzed the results of surgical resection for T1 esophageal cancers in 100 consecutive patients. Our data show that esophagectomy is safe and effective. The perioperative mortality was low and demonstrates the safety of primary surgery for

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