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Endoscopic ultrasound for early stage esophageal adenocarcinoma

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dc.contributor.author Azar, Riad
dc.contributor.author Crabtree, Traves D.
dc.contributor.author Yacoub, Wael N.
dc.contributor.author Puri, Varun
dc.contributor.author Zoole, Jennifer Bell
dc.contributor.author Patterson, G. Alexander
dc.date.accessioned 2016-06-22T10:17:50Z
dc.date.available 2016-06-22T10:17:50Z
dc.date.copyright 2011 en_US
dc.identifier.issn 0003-4975 en_US
dc.identifier.uri http://hdl.handle.net/10725/4128
dc.description.abstract Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) (p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy (p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection. en_US
dc.language.iso en en_US
dc.title Endoscopic ultrasound for early stage esophageal adenocarcinoma en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle implications for staging and survival en_US
dc.author.school SOM en_US
dc.author.idnumber 200902767 en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal The Annals of Thoracic Surgery en_US
dc.journal.volume 91 en_US
dc.journal.issue 5 en_US
dc.article.pages 1509-1516 en_US
dc.identifier.doi http://dx.doi.org/10.1016/j.athoracsur.2011.01.063 en_US
dc.identifier.ctation Crabtree, T. D., Yacoub, W. N., Puri, V., Azar, R., Zoole, J. B., Patterson, G. A., ... & Meyers, B. F. (2011). Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. The Annals of thoracic surgery, 91(5), 1509-1516. en_US
dc.author.email riad.azar@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url http://www.annalsthoracicsurgery.org/article/S0003-4975(11)00253-0/fulltext?refuid=S0003-4975(13)00741-8&refissn=0003-4975 en_US


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