The real risk of nodal disease in T1 oesophageal adenocarcinoma

Abstract

Lymph node status is regarded as an important factor in the prognosis of oesophageal cancer. T1 oesophageal adenocarcinoma management has to include endoscopic management as part of the algorithm. We reviewed the literature to assess the true risk of lymph node metastasis in patients with T1 oesophageal adenocarcinoma. Medline, Embase, PubMed and Cochrane where searched for manuscripts in English reviewing lymph node metastasis in superficial (T1) oesophageal adenocarcinoma. The main outcome was probability of lymph node metastasis in T1a and T1b oesophageal adenocarcinoma. Secondary outcome was the rate of lymph node metastasis of submucosal involvement of T1b (SM1, SM2 and SM3). There were 38 studies identified. 22 studies were excluded due to low lymph node yield (<15) or insufficient statistical analysis. For the 16 remaining studies, a total of 1382 cases were included: T1a adenocarcinoma (533 patients) with 11 (2%) node positive and T1b adenocarcinoma (849 patients) with 189 (22%) node positive. Subgroup analysis of T1b lesions was available in 8 reports (365 patients). Node positivity for SM1, SM2 and SM3 was 19.9%, 20.2% and 32.9%, respectively. T1a disease on endoscopic mucosal resection (EMR) demonstrates a 2% nodal metastasis rate, T1b disease a rate of 22%. T1a disease may be safely treated by EMR. T1a disease appears suitable for endoscopic therapy; however, T1b disease presents a high rate of nodal metastasis.