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The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns

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Abstract

Background

A prerequisite for endoscopic treatment (ET) of not only mucosal, but also submucosal early adenocarcinoma of the esophagus (EAC) would be a rate of lymph node (LN) metastasis below the mortality rate of esophagectomy (2–5 %). The aim of the present study was to evaluate the rate of LN metastasis in patients with pT1b sm1 EAC.

Methods

1996–2010, 1,718 patients with suspicion of EAC were referred to the Department of Internal Medicine II at HSK Wiesbaden. In 123/1718 patients, the suspicion (endoscopic ultrasound, EUS) or definitive diagnosis of sm1 EAC (ER/surgery) was made. Rate of LN metastasis was analyzed separately for low-risk (LR; G1–2, L0, V0) and high-risk lesions (HR; G3, L1, V1; ≥ 1 risk factor). LN metastasis was only evaluated in patients who had a proven maximum invasion depth of sm1 (ER and/or surgery), and who in case of ET had a follow-up (FU) by EUS of at least 24 months.

Results

Of the 72/123 patients included into the study, 49 patients had LR (68 %) and 23 HR lesions (32 %). In endoscopically treated LR patients (37/49), mean EUS-FU was 60 ± 30 mo (range 25–146); in HR patients undergoing ET (6/23), it was 63 ± 17 mo (46–86; p = 0.4). Mean number of resected LN was 27 ± 16 (12–62) in operated LR patients and 27 ± 10 (12–47) in HR-patients. The rate of LN metastasis was 2 % in the LR (1 patient) and 9 % in the HR group (2 patients; p = 0.24). Mortality of esophagectomy was 3 %.

Conclusions

The rate of LN metastasis in pT1b sm1 early adenocarcinoma with histological LR pattern was lower than the mortality rate of esophagectomy. ER may therefore be used alternatively to surgery in this group of patients.

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Disclosures

Authors Hendrik Manner, Oliver Pech, Yvonne Heldmann, Andrea May, Michael Pauthner, Dietmar Lorenz, Annette Fisseler-Eckhoff, Manfred Stolte, Michael Vieth, and Christian Ell have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine II, HSK Hospital, Teaching Hospital of the University Medicine of Mainz, Klinik Innere Medizin II, HSK Wiesbaden, Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany

    Hendrik Manner & Yvonne Heldmann

  2. Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany

    Oliver Pech

  3. Department of Internal Medicine II, Sana Klinikum Offenbach, Offenbach, Germany

    Andrea May & Christian Ell

  4. Department of Abdominal Surgery, Sana Klinikum Offenbach, Offenbach, Germany

    Michael Pauthner & Dietmar Lorenz

  5. Institute of Pathology, HSK Hospital, Wiesbaden, Germany

    Annette Fisseler-Eckhoff

  6. Institute of Pathology, Kulmbach Hospital, Kulmbach, Germany

    Manfred Stolte

  7. Institute of Pathology, Bayreuth Hospital, Bayreuth, Germany

    Michael Vieth

Authors
  1. Hendrik Manner
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  2. Oliver Pech
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  8. Manfred Stolte
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  9. Michael Vieth
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  10. Christian Ell
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Corresponding author

Correspondence to Hendrik Manner.

Additional information

This study formed the basis for Yvonne Heldmann’s doctoral thesis at the University of Mainz, Germany.

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Manner, H., Pech, O., Heldmann, Y. et al. The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc 29, 1888–1896 (2015). https://doi.org/10.1007/s00464-014-3881-3

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