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Esophageal adenocarcinoma p t1   sages
 

Esophageal adenocarcinoma p t1 sages

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    Esophageal adenocarcinoma p t1   sages Esophageal adenocarcinoma p t1 sages Presentation Transcript

    • Oncological Outcomes After Laparoscopic Trans-Hiatal Resection for pT1 Esophageal Adenocarcinoma Arin Saha, Simon Dexter & Abeezar Sarela Department of Upper GI & Minimally Invasive Surgery, Leeds, UK
    • Early Esophageal Adenocarcinoma
      • Resection is optimum treatment
      • Limited lymphadenectomy is adequate
      • Stein et al. Ann Surg 2000;232:733-42
      • Transhiatal vs. Transthoracic resection
        • similar long-term survival
        • lower peri-operative mortality
        • Chang et al. Ann Surg 2008;85:424-429
      • Laparoscopic trans-hiatal esophagectomy is safe and feasible
      • Sarela et al. SAGES 2007
    • Endoscopic Mucosal Resection
      • Definitive treatment for esophageal adenocarcinoma limited to mucosa (T1a) or submucosa (T1b)?
      • Limitations
        • Lymph node metastasis
        • Multi-focal cancer
        • Lymphovascular invasion
    • Aims
      • To describe pathological characteristics and clinical outcomes of laparoscopic transhiatal esophagectomy or open esophagectomy for pT1 adenocarcinoma
      • To identify patients who might be appropriate candidates for EMR
    • Patients & Operations Post-operative follow-up: median 44 months (range, 12-93) Jan 2000-Dec 2006 Esophagectomies for Adenocarcinoma 172 patients Pathological stage: T1 No neo-adjuvant therapy 44 patients (26%) Laparoscopic Transhiatal Esophagectomy 16 patients (36%) Open Ivor Lewis Esophagectomy 24 patients (55%) Open Transhiatal Esophagectomy 4 patients (9%)
    • Laparoscopic vs. Open Resection 16 (3-28) 19 (10-51) 15 (4-41) Lymph node retrieval 0 2 0 Post-operative Mortality Open Transhiatal 4 patients Open Ivor Lewis 24 patients Laparoscopic Transhiatal 16 patients
    • Pathological Characteristics Esophagectomy for pT1 adenocarcinoma 14 (32%) Tumor length > 1cm 31 (70%) Long segment Barrett’s (> 3cm) 4 (9%) Poor differentiation 11 (25%) Submucosal invasion (pT1b) No. of patients (%) Total: 44 patients Feature
    • Pathological Characteristics Esophagectomy for pT1 adenocarcinoma Aggregate number of patients who may have been inadequately treated by EMR: 29 (66%) 2 (5%) Lymphovascular invasion 27 (61%) Multifocal carcinoma or HGD 2 (5%) Lymph node metastasis No. of patients (%) Total : 44 patients Impediments to EMR
    • Oncological Outcome Esophagectomy for pT1 Adenocarcinoma Liver 22 N0 Poor T1a Open Ivor Lewis Liver 8 N1 Poor T1b Open Ivor Lewis Nodes 6 N0 Poor T1b Lap. Trans-Hiatal Site of recurrence Time to recurrence Node status Differentiation Tumor Depth Operation
    • Conclusions
      • Similar lymph node retrieval with laparoscopic trans-hiatal esophagectomy or open esophagectomy
      • Small but definite risk (7%) of recurrent disease after esophagectomy for T1 adenocarcinoma
      • No evidence of oncological detriment by laparoscopic resection
    • Conclusions
      • 66% of early esophageal adenocarcinoma may have been inadequately treated by EMR
      • EMR should be reserved for highly selected patients