Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk of lymph node metastases in patients with T1b oesophageal adenocarcinoma: A retrospective single centre experience
David Graham, Nejc Sever, Cormac Magee, William Waddingham, Matthew Banks, Rami Sweis, Hannah Al-Yousuf, Miriam Mitchison, Durayd Alzoubaidi, Manuel Rodriguez-Justo, Laurence Lovat, Marco Novelli, Marnix Jansen, Rehan Haidry
David Graham, Nejc Sever, Cormac Magee, William Waddingham, Matthew Banks, Rami Sweis, Hannah Al-Yousuf, Miriam Mitchison, Durayd Alzoubaidi, Manuel Rodriguez-Justo, Laurence Lovat, Marco Novelli, Marnix Jansen, Rehan Haidry, GI Services, University College London Hospital, London NW1 2BU, United Kingdom
David Graham, William Waddingham, Laurence Lovat, Marnix Jansen, Rehan Haidry, Division of Surgery and Science, University College London, London WC1E 6BT, United Kingdom
Nejc Sever, Gastroenterology Department, University Medical Center Ljubljana, Slovenia
Cormac Magee, Department of Metabolism and Experimental Therapeutics, University College London, London WC1E 6BT, United Kingdom
Author contributions: Graham D, Sever N and Haidry R designed the research, analysed data and wrote the paper; Magee C, Banks M, Sweis R, Lovat L, Novelli M, Jansen M and Haidry R designed the research, analysed data and reviewed paper; Waddingham W, Al-Yousuf H, Mitchison M and Rodriguez-Justo M designed the research and analysed data.
Institutional review board statement: The institutional review board approval was waived. However, this work was undertaken as a retrospective audit of patient care as part of service evaluation under the authorization of our local audit and governance guidelines.
Informed consent statement: Patients were not required to give informed consent to this study as the analysis used anonymous data that were obtained after each patient had agreed to to treatment by written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: I, Dr Rehan Haidry, Consultant Gastroenterologist and Honorary Senior Lecturer at University College Hospital, London confirm that our article contains all relevant features outlined in the STROBE checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: David Graham, BSc, MBBS, MRCP, Doctor, GI Services, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom. david.graham14@nhs.net
Telephone: +44-203-4477488 Fax: +44-203-4479217
Received: August 1, 2018
Peer-review started: August 1, 2018
First decision: August 24, 2018
Revised: September 29, 2018
Accepted: October 16, 2018
Article in press: October 16, 2018
Published online: November 7, 2018
ARTICLE HIGHLIGHTS
Research background
This study provides long-term outcome data on patients with submucosal oesophageal adenocarcinoma.
Research motivation
The optimal management of submucosal oesophageal adenocarcinoma is not clearly defined. Data suggests endoscopic therapy may be a viable alternative to surgery and thus radically change the treatment paradigm.
Research objectives
To analyse our data from a large tertiary specialist centre on the management of patients with submucosal oesophageal adenocarcinoma in order to support the potential for endoscopic therapy for these patients. In addition, we feel our work promotes the need for a large-scale multi-centre trial exploring endoscopic therapy for submucosal lesions.
Research methods
This was a retrospective cohort study that uniquely offers long-term outcomes on patients with high-risk and low-risk oesophageal submucosal lesions who received surgery and endoscopic therapy.
Research results
Lymph node metastases were detected in 18% of patients who had undergone conservative management. There was no statistically significant difference in tumour-related deaths between those treated surgically or conservatively and disease-specific survival time was also comparable between the two treatment strategies.
Research conclusions
This study provides supporting data for the potential of endoscopic therapy in the management of submucosal oesophageal adenocarcinoma. In particular, the work suggests that endoscopic therapy may be a viable alternative to surgery in selected patients. This work could support a change to the treatment strategy for submucosal lesions.
Research perspectives
Low-risk submucosal lesions can be safely treated endoscopically whilst our research suggests that endoscopic therapy may be a viable option for high-risk lesions. This study supports the need for a large-scale multicentre study addressing this uncertainty in the treatment paradigm.
