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Risk of lymph node metastasis in T1 esophageal adenocarcinoma: a meta-analysis

  • 0Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia.
Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus +

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February 23, 2024

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February 23, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Accurate identification of lymph node metastasis (LNM) risk in early esophageal adenocarcinoma (EAC) is crucial. T1a EAC has a 4.2% LNM rate, while T1b EAC has a 23.2% rate, guiding treatment decisions.

Area Of Science

  • Gastroenterology
  • Surgical Oncology
  • Pathology

Background

  • Early esophageal adenocarcinoma (EAC) management increasingly utilizes endoscopic resection.
  • Endoscopic resection cannot accurately stage or treat lymph node metastasis (LNM).
  • Accurate LNM identification is critical for selecting between endoscopic therapy and surgery.

Purpose Of The Study

  • To define the risk of lymph node metastasis (LNM) in early (T1) esophageal adenocarcinoma (EAC).
  • To identify risk factors associated with LNM in T1 EAC.
  • To stratify LNM risk within T1b submucosal (SM) disease stages.

Main Methods

  • A meta-analysis was conducted on studies of T1 EAC patients who underwent surgery and lymphadenectomy.
  • PRISMA guidelines were followed for study selection and data extraction.
  • Main outcomes included the probability of LNM in T1a and T1b disease, with secondary outcomes focusing on risk factors and SM disease stratification.

Main Results

  • Twenty cohort studies involving 2264 patients met inclusion criteria.
  • T1a EAC showed a 4.2% LNM rate (36/857 patients), while T1b EAC had a 23.2% LNM rate (327/1407 patients).
  • T1 substage, tumor differentiation, and lymphovascular invasion were significant risk factors for LNM.

Conclusions

  • Endoscopic therapy should be reserved for T1a EAC.
  • Select T1b EAC cases may be candidates for endoscopic therapy, but the moderately high LNM rate requires careful consideration.
  • Current data are insufficient to stratify T1b submucosal disease into low-risk and high-risk categories based on tumor differentiation and LVI.

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