Background:
Esophagectomy is recommended after endoscopic resection of an early
esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. Patients and Methods: This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early
esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by
chemoradiotherapy or follow-up in case of surgical
contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS),
cancer specific survival (CSS) and toxicity of
chemoradiotherapy. Results: Forty-one patients (36 with
squamous cell carcinoma and 5 with
adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by
chemoradiotherapy or
radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the
chemoradiotherapy group at the end of the follow-up. Serious adverse events related to
chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. Conclusions: Our study shows that close follow-up may be an alternative to systematic
esophagectomy after endoscopic resection of early
esophageal cancer with a predicted high risk of lymph node involvement.