Sa1651 Rate of Lymph Node Metastasis and Outcome of Endoscopic Resection for High Grade Dysplasia and Superficial Adenocarcinoma of the Esophagogastric Junction

Abstract

Sa1651 Rate of Lymph Node Metastasis and Outcome of Endoscopic Resection for High Grade Dysplasia and Superficial Adenocarcinoma of the Esophagogastric Junction Masayoshi Yamada*, Ichiro Oda, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito, Hirokazu Taniguchi, Shigeki Sekine, Ryoji Kushima Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Pathology Division, National Cancer Center Hospital, Tokyo, Japan Background: In the esophagogastoric junction (EGJ), high grade dysplasia (HGD) and intramucosal adenocarcinoma are generally treated by endoscopic resection (ER). There have been a few reports about ER for minute submucosal adenocarcinoma. The aim of this study is to investigate the possibility of ER for minute submucosal adenocarcinoma based on rate of lymph node metastasis (LNM) of surgical cases and outcome after ER at the EGJ. Material and methods: 1. We reviewed 69 consecutive surgically resected cases of HGD and superficial carcinomas (T1) (M/F 56/13, median age 66 years old (33-85), median tumor size 28 mm (7-97), and Barrett’s adenocarcinoma (BA)/non-BA 33/36) and analyzed the rate of LNM.2. We reviewed 78 consecutive endoscopically resected cases (M/F 67/11, median age 68 years old (39-88), median tumor size 19mm (3-63), BA/non-BA 32/46) and analyzed the outcome of ER. We defined HGD and adenocarcinoma of the EGJ when the tumor was classified as Siewert type II. Depth of invasion was divided into HGD/mucosa (M) (excluding muscularis mucosae (MM)), MM, submucosa 1 (SM1) ( 500 m into the submucosa) and SM2 ( 500 m). Histological types were divided into two groups; intestinal or diffuse type, by major histological features. We defined curative resection (CR) as a tumor with HGD/M/MM/SM1, intestinal type, negative for lymphovascular (ly/ v) invasion and negative margins. Results: 1. The rates of LNM were 14.5% (10/ 69) for all cases, 0% (0/5) for M, 14.3% (1/7) for MM, 0% (0/13) for SM1, 20.5% (9/44) for SM2. The rates of LNM were 36.8% (7/19) / 6% (3/50) for positive / negative of the ly/v invasion (p 0.01). The rates of LNM were 12.9% (8/62) / 28.6% (2/7) for intestinal / diffuse type, 13.3% (4/30) / 15.4% (6/39) for 3cm / 3cm in size, 15.2% (5/33) / 13.9% (5/36) for BA / non-BA, respectively. The MM carcinoma with lymph node metastasis had a ly/v invasion.2. En-bloc resection, en-bloc with R0 resection and CR rates were 97.4% (76/78), 82.1% (64/ 78) and 68.0% (53/78), respectively. Median procedure time was 75 minutes (20480). Perforation and stenosis occurred in 1.3% (1/78) and 10.3% (8/78), respectively. All of these cases were treated successfully with endoscopy. None of the patients with CR had recurrence with 3.4 years (0.2-10) of median followup period. The 3-year survival rate of the patients with CR was 100%. However, two patients with non-CR (SM2) died of the disease. One patient had a local recurrence 4 years after additional surgical treatment and another patient, who refused additional surgical treatment, developed lung metastasis 3 years after the ER. Conclusions: ER of superficial adenocarcinoma of EGJ may be indicated for SM1 or less tumor with intestinal type adenocarcinoma. Additional surgical treatment should be subsequently required in cases with ly/v invasion and/or tumor invasion into SM2 after ER.