TY - JOUR
T1 - Management of high risk T1 esophageal adenocarcinoma following endoscopic resection
AU - Leclercq, Philippe
AU - Bisschops, Raf
AU - Bergman, Jacques J. G. H. M.
AU - Pouw, Roos E.
N1 - Publisher Copyright: © 2024 Elsevier Ltd
PY - 2024/2
Y1 - 2024/2
N2 - High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact. Parallel to this development, new publications demonstrated that the risk of lymph node metastases for HR-T1 EAC may be even <24%. Therefore, indications for endoscopic treatment of HR-T1 EAC are being reconsidered and current research aims at finding the optimal management strategy for this indication, where watchful waiting may proof to be an acceptable strategy in selected patients. In this review, we will discuss the latest developments in this field.
AB - High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact. Parallel to this development, new publications demonstrated that the risk of lymph node metastases for HR-T1 EAC may be even <24%. Therefore, indications for endoscopic treatment of HR-T1 EAC are being reconsidered and current research aims at finding the optimal management strategy for this indication, where watchful waiting may proof to be an acceptable strategy in selected patients. In this review, we will discuss the latest developments in this field.
KW - Barrett's esophagus
KW - Endoscopic resection
KW - Endoscopic submucosal dissection
KW - High-risk esophageal adenocarcinoma
UR - http://www.scopus.com/inward/record.url?scp=85185569714&partnerID=8YFLogxK
U2 - 10.1016/j.bpg.2024.101882
DO - 10.1016/j.bpg.2024.101882
M3 - Review article
C2 - 38522880
SN - 1521-6918
VL - 68
JO - Best practice & research. Clinical gastroenterology
JF - Best practice & research. Clinical gastroenterology
M1 - 101882
ER -