Introduction Currently patients with Stage 1 (T1/T2 N0) oesophageal cancer proceed straight to surgery; these patients have an expected 60%–90% 5 year survival. This staging is based on EUS (endoscopic ultrasound) and CT imaging, which are accurate in 90% and 70% for T stage respectively and 70% in N stage for EUS. However, reporting of postoperative histology reveals a significant proportion of these patients end up with locally advanced (T3 N1/0) disease, leading to a 5-year survival of 25%. The aim of this study is to assess the results based on the current UK protocols.
Methods This study includes all patients who underwent an oesophagectomy over a 4-year period (2008–2011), focusing on those with T1/T2 N0 disease. After comprehensive staging which included endoscopy, EUS, CT and PET scanning all patients results were reviewed. Data on patients with T1/T2 N0 disease who went straight to surgery were analysed. The primary end points included a review of the number of patients who had a higher staging on post-operative histology and also the peri-operative mortality, morbidity and survival.
Results 167 oesophagectomies were carried out during the study period in our institution, of which 26 (15.6%) were for preoperatively staged T1/T2 N0 disease (6 T1 and 20 T2). The mean age was 68 years and 18 (69.2%) of the patients were male. Ivor-Lewis oesophagectomies were performed on 23 patients, minimally invasive 3-stage procedures in 2 and 1 had a trans-hiatal operation. Post-operative histology indicated a higher stage of disease in 54% (14) of patients, 10 had a T3 lesion while 10 patients were noted to have nodal disease. One (3.8%) patient died on the 8th post-op day with bowel ischaemia and major or minor complications occurred in 11 (42%) of patients peri-operatively. Disease recurrence was seen in 4 (15.3%) patients at 15 to 18 months post-operatively, 3 (75%) of these had stage migration on histology to a higher stage and two have died.
Conclusion Our study concludes that in patients with T1/2 N0 oesophageal cancer, despite the high specificity and sensitivity of both EUS and CT scan we still seem to have a large proportion of patients who are under staged and often offered curative operations, which appear to result in sub-optimal management leading to early recurrence and poorer long-term outcomes. Further studies are essential for accurate assessment of this stage of disease so that appropriate treatment strategies can be implemented for the management of oesophageal cancer.
Competing interests None declared.
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