RA04.06: Esophagectomy in Patients With Early Stage Esophageal Cancer After Non-Curative Endoscopic Submucosal Dissection

Abstract

Background Early stage esophageal cancer has a low risk of lymph node metastasis. Therefore, an organ preserving endoscopic submucosal resection for tumors staged uT1 N0 has already been established. In case of non-curative dissection according to oncologic criteria esophagectomy has to be performed to achieve an oncologic resection. Methods Between 2010 and 2016 42 patients with early stage esophageal cancer underwent endoscopic submucosal dissections (ESD). We retrospectively evaluated the operative and pathologic outcome as well as disease free and overall survival in patients, who were operated on with esophagectomy because of non-curative endoscopic resection. Results 5 of 42 (11.9%) had to be operated on: 3 patients with open abdominothoracal resektion with intrathoracal anastomosis, 1 patient with an open approach and a cervical anastomosis and 1 patient with an laparoscopic/thoracoscopic approach but open intrathoracic anastomosis. Reasons for ongoing resection were three times R1 endoscopic resection, one L1 infiltration and one sm1-infiltration in a squamous cell carcinoma. There was no perioperative mortality. One anastomotic leakage was treated interventionally, one thoracic surgical site infection conservatively. One anastomotic leakage had to be resected, put on a saliva fistula and reconstructed with a colonic interponate. No recurrence of cancer is observed so far. Conclusion Esophagectomy after non-curative ESD shows no evidence for a worse oncologic outcome. There is no higher peri- and postoperative risk. This legitimates our step-up approach. Disclosure All authors have declared no conflicts of interest.