Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases
Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarc...
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| Veröffentlicht in: | United European Gastroenterology Journal 2021-04, Vol.9 (3), p.362-369 |
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| creator | Benech, Nicolas O'Brien, Jean Marc Barret, Maximilien Jacques, Jéremie Rahmi, Gabriel Perrod, Guillaume Hervieu, Valérie Jaouen, Alexandre Charissoux, Aurélie Guillaud, Olivier Legros, Romain Walter, Thomas Saurin, Jean‐Christophe Rivory, Jérôme Prat, Fréderic Lépilliez, Vincent Ponchon, Thierry Pioche, Mathieu |
| description | Background
Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce.
Objective
Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma.
Methods
We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible.
Results
In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%).
Conclusion
Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.
Key Summary
Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.
Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.
Curative endoscopic resections have been rep |
| doi_str_mv | 10.1177/2050640620958903 |
| format | Article |
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Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce.
Objective
Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma.
Methods
We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (<1000 mm) and deep submucosal (>1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible.
Results
In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%).
Conclusion
Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.
Key Summary
Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.
Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.
Curative endoscopic resections have been reported in selected OAC invading the first 500 mm of the submucosa, but surgical series showed an LNM risk ranging from 0% to 50%, making endoscopic resection a questionable curative treatment.
High‐risk histological features were not associated with LNM in intramucosal tumours.
LNM occurred only for tumours invading the submucosa with a depth ≥1200 mm or with high‐risk histological features regardless of the depth of invasion.
Endoscopic resection may be a valid and curative therapeutic option for all intramucosal tumours and for submucosal oesophageal adenocarcinoma with an invasion depth ≤1000 mm and low‐risk histological features.</description><identifier>ISSN: 2050-6406</identifier><identifier>EISSN: 2050-6414</identifier><identifier>DOI: 10.1177/2050640620958903</identifier><identifier>PMID: 32903167</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Adenocarcinoma ; Adenocarcinoma - diagnostic imaging ; Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Barrett Esophagus - diagnostic imaging ; Barrett Esophagus - mortality ; Barrett Esophagus - pathology ; Barrett Esophagus - surgery ; Barrett's oesophagus ; Cancer ; Chemotherapy ; Endoscopy ; Esophageal cancer ; Esophageal Mucosa - diagnostic imaging ; Esophageal Mucosa - pathology ; Esophageal Neoplasms - diagnostic imaging ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagoscopy - adverse effects ; Female ; Follow-Up Studies ; France ; histological features ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Life Sciences ; lymph node metastasis ; Lymphatic Metastasis ; Lymphatic system ; Male ; Medical imaging ; Metastasis ; Middle Aged ; Mortality ; Neoplasm Invasiveness ; oesophageal adenocarcinoma ; Original ; Pathology ; Patients ; Positron-Emission Tomography ; Retrospective Studies ; Risk ; Software ; Standard of care ; Statistical analysis ; submucosal invasion ; Surgery ; Teaching hospitals ; Tumors</subject><ispartof>United European Gastroenterology Journal, 2021-04, Vol.9 (3), p.362-369</ispartof><rights>2020 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.</rights><rights>COPYRIGHT 2021 John Wiley & Sons, Inc.</rights><rights>2021. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5733-b559448e3777f392b936ac6f2cecc3287eafec909584fbfcaa042a438beb1c4b3</citedby><cites>FETCH-LOGICAL-c5733-b559448e3777f392b936ac6f2cecc3287eafec909584fbfcaa042a438beb1c4b3</cites><orcidid>0000-0003-4984-0310 ; 0000-0002-4199-4561 ; 0000-0002-2694-2325 ; 0000-0002-6482-2375</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259244/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259244/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,11562,27924,27925,45574,45575,46052,46476,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32903167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04470221$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Benech, Nicolas</creatorcontrib><creatorcontrib>O'Brien, Jean Marc</creatorcontrib><creatorcontrib>Barret, Maximilien</creatorcontrib><creatorcontrib>Jacques, Jéremie</creatorcontrib><creatorcontrib>Rahmi, Gabriel</creatorcontrib><creatorcontrib>Perrod, Guillaume</creatorcontrib><creatorcontrib>Hervieu, Valérie</creatorcontrib><creatorcontrib>Jaouen, Alexandre</creatorcontrib><creatorcontrib>Charissoux, Aurélie</creatorcontrib><creatorcontrib>Guillaud, Olivier</creatorcontrib><creatorcontrib>Legros, Romain</creatorcontrib><creatorcontrib>Walter, Thomas</creatorcontrib><creatorcontrib>Saurin, Jean‐Christophe</creatorcontrib><creatorcontrib>Rivory, Jérôme</creatorcontrib><creatorcontrib>Prat, Fréderic</creatorcontrib><creatorcontrib>Lépilliez, Vincent</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Pioche, Mathieu</creatorcontrib><title>Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases</title><title>United European Gastroenterology Journal</title><addtitle>United European Gastroenterol J</addtitle><description>Background
Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce.
Objective
Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma.
Methods
We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (<1000 mm) and deep submucosal (>1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible.
Results
In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%).
Conclusion
Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.
Key Summary
Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.
Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.
Curative endoscopic resections have been reported in selected OAC invading the first 500 mm of the submucosa, but surgical series showed an LNM risk ranging from 0% to 50%, making endoscopic resection a questionable curative treatment.
High‐risk histological features were not associated with LNM in intramucosal tumours.
LNM occurred only for tumours invading the submucosa with a depth ≥1200 mm or with high‐risk histological features regardless of the depth of invasion.
Endoscopic resection may be a valid and curative therapeutic option for all intramucosal tumours and for submucosal oesophageal adenocarcinoma with an invasion depth ≤1000 mm and low‐risk histological features.</description><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - diagnostic imaging</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Barrett Esophagus - diagnostic imaging</subject><subject>Barrett Esophagus - mortality</subject><subject>Barrett Esophagus - pathology</subject><subject>Barrett Esophagus - surgery</subject><subject>Barrett's oesophagus</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Endoscopy</subject><subject>Esophageal cancer</subject><subject>Esophageal Mucosa - diagnostic imaging</subject><subject>Esophageal Mucosa - pathology</subject><subject>Esophageal Neoplasms - diagnostic imaging</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagoscopy - adverse effects</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>France</subject><subject>histological features</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Life Sciences</subject><subject>lymph node metastasis</subject><subject>Lymphatic Metastasis</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasm Invasiveness</subject><subject>oesophageal adenocarcinoma</subject><subject>Original</subject><subject>Pathology</subject><subject>Patients</subject><subject>Positron-Emission Tomography</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Software</subject><subject>Standard of care</subject><subject>Statistical analysis</subject><subject>submucosal invasion</subject><subject>Surgery</subject><subject>Teaching hospitals</subject><subject>Tumors</subject><issn>2050-6406</issn><issn>2050-6414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqFks9u1DAQxiMEolXpnROyxAF62OJ_iRMOlZZqaSutxIWeLceZdF0Se7GTrvaGxAv0GXkSZpWygr1gW7I1_n3f2KPJsteMnjOm1AdOc1pIWnBa5WVFxbPseBeaFZLJ5_szLY6y05TuKY6ylJzLl9mR4MizQh1nPxe-CcmGtbMkQgI7uOBJaMknEyMMw7tETAM-WBOt86E3H8mNH6LpRxuS6YjxDenC5tePx-jSNzKMfRgjaiIQHwZiUgrWmQEasnHDinTbfr3CmwZID4NJuCC9yl60pktw-rSfZLefF18vr2fLL1c3l_PlzOZKiFmd55WUJQilVCsqXleiMLZouQVrBS8VmBZstauGbOvWGkMlN1KUNdTMylqcZBeT73qse2gs7D7S6XV0vYlbHYzT_954t9J34UGXPK-4lGhwNhmsDmTX86XexaiUinLOHhiy75-SxfB9hDTo3iULXWc8hDFp9GMFLSuWI_r2AL3HInoshRa0QqZSgiN1PlF3pgPtfBvwjRZnA72zwUPrMD5XQtGcF6JEAZ0ENoaUIrT7JzOqdx2kDzsIJW_-rtBe8KdfEFATsMFk2_8a6tvFFWccncVv2lXSzQ</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Benech, Nicolas</creator><creator>O'Brien, Jean Marc</creator><creator>Barret, Maximilien</creator><creator>Jacques, Jéremie</creator><creator>Rahmi, Gabriel</creator><creator>Perrod, Guillaume</creator><creator>Hervieu, Valérie</creator><creator>Jaouen, Alexandre</creator><creator>Charissoux, Aurélie</creator><creator>Guillaud, Olivier</creator><creator>Legros, Romain</creator><creator>Walter, Thomas</creator><creator>Saurin, Jean‐Christophe</creator><creator>Rivory, Jérôme</creator><creator>Prat, Fréderic</creator><creator>Lépilliez, Vincent</creator><creator>Ponchon, Thierry</creator><creator>Pioche, Mathieu</creator><general>John Wiley & Sons, Inc</general><general>SAGE Publications</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4984-0310</orcidid><orcidid>https://orcid.org/0000-0002-4199-4561</orcidid><orcidid>https://orcid.org/0000-0002-2694-2325</orcidid><orcidid>https://orcid.org/0000-0002-6482-2375</orcidid></search><sort><creationdate>202104</creationdate><title>Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases</title><author>Benech, Nicolas ; O'Brien, Jean Marc ; Barret, Maximilien ; Jacques, Jéremie ; Rahmi, Gabriel ; Perrod, Guillaume ; Hervieu, Valérie ; Jaouen, Alexandre ; Charissoux, Aurélie ; Guillaud, Olivier ; Legros, Romain ; Walter, Thomas ; Saurin, Jean‐Christophe ; Rivory, Jérôme ; Prat, Fréderic ; Lépilliez, Vincent ; Ponchon, Thierry ; Pioche, Mathieu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5733-b559448e3777f392b936ac6f2cecc3287eafec909584fbfcaa042a438beb1c4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma</topic><topic>Adenocarcinoma - diagnostic imaging</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Barrett Esophagus - diagnostic imaging</topic><topic>Barrett Esophagus - mortality</topic><topic>Barrett Esophagus - pathology</topic><topic>Barrett Esophagus - surgery</topic><topic>Barrett's oesophagus</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Endoscopy</topic><topic>Esophageal cancer</topic><topic>Esophageal Mucosa - diagnostic imaging</topic><topic>Esophageal Mucosa - pathology</topic><topic>Esophageal Neoplasms - diagnostic imaging</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagoscopy - adverse effects</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>France</topic><topic>histological features</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Life Sciences</topic><topic>lymph node metastasis</topic><topic>Lymphatic Metastasis</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasm Invasiveness</topic><topic>oesophageal adenocarcinoma</topic><topic>Original</topic><topic>Pathology</topic><topic>Patients</topic><topic>Positron-Emission Tomography</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Software</topic><topic>Standard of care</topic><topic>Statistical analysis</topic><topic>submucosal invasion</topic><topic>Surgery</topic><topic>Teaching hospitals</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Benech, Nicolas</creatorcontrib><creatorcontrib>O'Brien, Jean Marc</creatorcontrib><creatorcontrib>Barret, Maximilien</creatorcontrib><creatorcontrib>Jacques, Jéremie</creatorcontrib><creatorcontrib>Rahmi, Gabriel</creatorcontrib><creatorcontrib>Perrod, Guillaume</creatorcontrib><creatorcontrib>Hervieu, Valérie</creatorcontrib><creatorcontrib>Jaouen, Alexandre</creatorcontrib><creatorcontrib>Charissoux, Aurélie</creatorcontrib><creatorcontrib>Guillaud, Olivier</creatorcontrib><creatorcontrib>Legros, Romain</creatorcontrib><creatorcontrib>Walter, Thomas</creatorcontrib><creatorcontrib>Saurin, Jean‐Christophe</creatorcontrib><creatorcontrib>Rivory, Jérôme</creatorcontrib><creatorcontrib>Prat, Fréderic</creatorcontrib><creatorcontrib>Lépilliez, Vincent</creatorcontrib><creatorcontrib>Ponchon, Thierry</creatorcontrib><creatorcontrib>Pioche, Mathieu</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>United European Gastroenterology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Benech, Nicolas</au><au>O'Brien, Jean Marc</au><au>Barret, Maximilien</au><au>Jacques, Jéremie</au><au>Rahmi, Gabriel</au><au>Perrod, Guillaume</au><au>Hervieu, Valérie</au><au>Jaouen, Alexandre</au><au>Charissoux, Aurélie</au><au>Guillaud, Olivier</au><au>Legros, Romain</au><au>Walter, Thomas</au><au>Saurin, Jean‐Christophe</au><au>Rivory, Jérôme</au><au>Prat, Fréderic</au><au>Lépilliez, Vincent</au><au>Ponchon, Thierry</au><au>Pioche, Mathieu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases</atitle><jtitle>United European Gastroenterology Journal</jtitle><addtitle>United European Gastroenterol J</addtitle><date>2021-04</date><risdate>2021</risdate><volume>9</volume><issue>3</issue><spage>362</spage><epage>369</epage><pages>362-369</pages><issn>2050-6406</issn><eissn>2050-6414</eissn><abstract>Background
Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce.
Objective
Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma.
Methods
We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (<1000 mm) and deep submucosal (>1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible.
Results
In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%).
Conclusion
Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series.
Key Summary
Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.
Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.
Curative endoscopic resections have been reported in selected OAC invading the first 500 mm of the submucosa, but surgical series showed an LNM risk ranging from 0% to 50%, making endoscopic resection a questionable curative treatment.
High‐risk histological features were not associated with LNM in intramucosal tumours.
LNM occurred only for tumours invading the submucosa with a depth ≥1200 mm or with high‐risk histological features regardless of the depth of invasion.
Endoscopic resection may be a valid and curative therapeutic option for all intramucosal tumours and for submucosal oesophageal adenocarcinoma with an invasion depth ≤1000 mm and low‐risk histological features.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>32903167</pmid><doi>10.1177/2050640620958903</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4984-0310</orcidid><orcidid>https://orcid.org/0000-0002-4199-4561</orcidid><orcidid>https://orcid.org/0000-0002-2694-2325</orcidid><orcidid>https://orcid.org/0000-0002-6482-2375</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2050-6406 |
| ispartof | United European Gastroenterology Journal, 2021-04, Vol.9 (3), p.362-369 |
| issn | 2050-6406 2050-6414 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8259244 |
| source | MEDLINE; Wiley Journals; Wiley Online Library (Open Access Collection); PubMed Central |
| subjects | Adenocarcinoma Adenocarcinoma - diagnostic imaging Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Barrett Esophagus - diagnostic imaging Barrett Esophagus - mortality Barrett Esophagus - pathology Barrett Esophagus - surgery Barrett's oesophagus Cancer Chemotherapy Endoscopy Esophageal cancer Esophageal Mucosa - diagnostic imaging Esophageal Mucosa - pathology Esophageal Neoplasms - diagnostic imaging Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagoscopy - adverse effects Female Follow-Up Studies France histological features Human health and pathology Humans Hépatology and Gastroenterology Life Sciences lymph node metastasis Lymphatic Metastasis Lymphatic system Male Medical imaging Metastasis Middle Aged Mortality Neoplasm Invasiveness oesophageal adenocarcinoma Original Pathology Patients Positron-Emission Tomography Retrospective Studies Risk Software Standard of care Statistical analysis submucosal invasion Surgery Teaching hospitals Tumors |
| title | Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases |
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