Management of high risk T1 esophageal adenocarcinoma following endoscopic resection

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-02-01 DOI:10.1016/j.bpg.2024.101882

Philippe Leclercq , Raf Bisschops , Jacques J.G.H.M. Bergman , Roos E. Pouw

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引用次数: 0

Abstract

High-risk T1 esophageal adenocarcinoma (HR-T1 EAC) is defined as T1 cancer, with one or more of the following histological criteria: submucosal invasion, poorly or undifferentiated cancer, and/or presence of lympho-vascular invasion. Esophagectomy has long been the only available treatment for these HR-T1 EACs and was considered necessary because of a presumed high risk of lymph node metastases up to 46%. However, endoscopic submucosal disscection have made it possible to radically remove HR-T1 EAC, irrespective of size, while leaving the esophageal anatomy intact. Parallel to this development, new publications demonstrated that the risk of lymph node metastases for HR-T1 EAC may be even <24%. Therefore, indications for endoscopic treatment of HR-T1 EAC are being reconsidered and current research aims at finding the optimal management strategy for this indication, where watchful waiting may proof to be an acceptable strategy in selected patients. In this review, we will discuss the latest developments in this field.

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内镜切除术后高风险 T1 食管腺癌的处理方法

高风险 T1 食管腺癌（HR-T1 EAC）被定义为 T1 癌症，同时具备以下一项或多项组织学标准：粘膜下侵犯、低分化或未分化癌和/或存在淋巴管侵犯。长期以来，食管切除术一直是治疗这些 HR-T1 EAC 的唯一方法，而且由于推测淋巴结转移的风险高达 46%，因此食管切除术被认为是必要的。然而，内镜下粘膜下切除术使得从根本上切除 HR-T1 EAC（无论其大小）成为可能，同时保留食管解剖结构不变。与此同时，新发表的文章表明，HR-T1 EAC 的淋巴结转移风险甚至可能高达 24%。因此，HR-T1 EAC 的内镜治疗适应症正在被重新考虑，目前的研究旨在为这一适应症找到最佳的治疗策略，在这种情况下，观察等待可能被证明是某些患者可以接受的策略。在这篇综述中，我们将讨论这一领域的最新进展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Best Practice & Research Clinical Gastroenterology 医学-胃肠肝病学

CiteScore

5.50

自引率

0.00%

发文量

审稿时长

69 days

期刊介绍： Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.