PS02.093: LYMPH NODE METASTASES IN T1 OESOPHAGEAL ADENOCARCINOMA: WHAT IS THE REAL RISK IN EARLY OESOPHAGEAL CANCER?

Abstract

Abstract Background Lymph node status is regarded as the most important factor for prognosis for oesophageal cancer. T1 oesophageal adenocarcinoma management has shifted from oesophagectomy only to include endoscopic management as part of the algorithm, with some bodies (National Comprehensive Cancer Network (NCCN) 2016) recommending it for management of T1a disease and selected T1b disease. We reviewed the literature to assess the true risk of lymph node metastasis in patients with T1 oesophageal adenocarcinoma. Methods Medline, Embase, Pubmed and Cochrane where searched for manuscripts in english reviewing the lymph node metastasis in superficial (T1) oesophageal adenocarcinoma. The main outcome was reviewing the risk of lymph node metastasis in T1a and T1b oesophageal adenocarcinoma. Secondary outcomes looked at the rate of lymph node metastasis for T1b cancers based on degree of submucosal involvement (SM1, SM2 and SM3). Studies were excluded if neo-adjuvant chemotherapy or radiotherapy were received and if the surgical lymph node yield was < 15 lymph nodes. Results 38 Studies were identified. 22 studies were excluded due to low lymph node yield (< 15) or insufficient statistical analysis. For the 16 studies, a total of 1422 cases were included. 533 patients had T1a adenocarcinoma with 11 patients demonstrating positive lymph nodes (2%). 849 had T1b adenocarcinoma with 189 patients demonstrating positive lymph nodes (22%). Eight Studies did subgroup analysis of T1b lesions with a total of 365 patients identified. The rate of lymph node positivity for SM1, SM2 and SM3 was 17.9%, 16.6% and 29.6% respectively. Conclusion Early oesophageal adenocarcinoma (T1) is increasing in prevalence due to surveillance of pre-malignant conditions (Barrett's Oesophagus). Recently some bodies recommend the use of endoscopic mucosal resection as first line therapy for T1a disease. It is important to inform our patients the risk of lymph node metastasis is low but significant (2%). Given in specialised units, oesophagectomy can be performed with low mortality (< 1%) and morbidity with good quality of life it is justifiable to recommend oesophagectomy or endoscopic management in patients who are fit enough for surgery. For T1b disease an oesophagectomy is the gold standard of treatment given the significant risk of lymph node positivity (22%). Disclosure All authors have declared no conflicts of interest.