The 7th Joint Session between JDDW-KDDW-TDDW2(JDDW)
Thu. November 2nd   14:00 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
Exploring the feasibility of endoscopic management for T1b esophageal cancer
Chu-Kuang Chou
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital
Based on data from the Taiwan cancer registry, the overall crude incidence rate of esophageal cancer in 2020 was reported to be 12.19, and this rate has remained stable over the past decade in Taiwan. The majority of esophageal cancer cases are of squamous origin, while adenocarcinoma from the esophagogastric junction (EGJ) constitutes 4.21-4.79% of cases. Among all esophageal cancer cases, 9.24% were classified as clinical stage 1, and 14.49% were categorized as pathologic stage 1.

The advancement and acceptance of endoscopic resection have led to a shift in the management of early EGJ cancers, moving away from surgery or concurrent chemoradiation therapy (CCRT) and towards endoscopic treatment. En-bloc resection using endoscopic submucosal dissection (ESD) has become a crucial approach for EGJ lesions with suspected superficial invasive cancers.
The management of squamous cell carcinoma near the EGJ in Taiwan closely mirrors that of squamous cell carcinoma at other sites in the esophagus.
As for adenocarcinoma, the en bloc resection rate for ESD in esophageal adenocarcinoma is higher than that of endoscopic mucosal resection (EMR). ESD is considered the preferred treatment for elevated lesions and those with potential invasive cancers, allowing endoscopists to obtain a definitive diagnosis. Nonetheless, managing submucosal invasion cancers remains challenging. The Japan Gastroenterological Endoscopy Society 2020 guideline for Endoscopic submucosal dissection/endoscopic mucosal resection in esophageal cancer suggests that pT1b esophageal adenocarcinoma should be considered for surgical resection. The European Society of Gastrointestinal Endoscopy 2022 guideline suggests that Barrett's esophagus-associated superficial cancers with superficial submucosal invasion, showing well to moderate differentiation and lacking lymphovascular invasion, can be effectively treated endoscopically. Additionally, a clinical update on T1b Esophageal Cancer in the United States in 2019 reported a low risk (6% metastasis rate) of lymph node metastasis in esophageal adenocarcinoma with submucosal invasion <500 μm. The management of pT1b esophageal adenocarcinoma should take into account the risk of lymph node metastasis and carefully weigh the risks and benefits of additional surgery or concurrent chemoradiation therapy. Further research and data collection are essential to strengthen the existing body of evidence. In this section, we aim to provide an in-depth review of the current evidence and share our institution's case experience concerning T1b EGJ cancer.
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