- The document examines pathological characteristics and clinical outcomes of laparoscopic transhiatal esophagectomy or open esophagectomy for pT1 esophageal adenocarcinoma. - It found that 66% of patients with pT1 adenocarcinoma had characteristics like lymphovascular invasion or multifocal carcinoma that would make them inappropriate candidates for endoscopic mucosal resection (EMR) alone. - EMR should be reserved for highly selected pT1 adenocarcinoma patients, as esophagectomy had a small but definite risk of recurrent disease, but provided similar lymph node retrieval and no evidence of oncological detriment from the laparoscopic approach.

1. Oncological Outcomes After Laparoscopic Trans-Hiatal Resection for pT1 Esophageal Adenocarcinoma Arin Saha, Simon Dexter & Abeezar Sarela Department of Upper GI & Minimally Invasive Surgery, Leeds, UK

5. Patients & Operations Post-operative follow-up: median 44 months (range, 12-93) Jan 2000-Dec 2006 Esophagectomies for Adenocarcinoma 172 patients Pathological stage: T1 No neo-adjuvant therapy 44 patients (26%) Laparoscopic Transhiatal Esophagectomy 16 patients (36%) Open Ivor Lewis Esophagectomy 24 patients (55%) Open Transhiatal Esophagectomy 4 patients (9%)

6. Laparoscopic vs. Open Resection 16 (3-28) 19 (10-51) 15 (4-41) Lymph node retrieval 0 2 0 Post-operative Mortality Open Transhiatal 4 patients Open Ivor Lewis 24 patients Laparoscopic Transhiatal 16 patients

7. Pathological Characteristics Esophagectomy for pT1 adenocarcinoma 14 (32%) Tumor length > 1cm 31 (70%) Long segment Barrett’s (> 3cm) 4 (9%) Poor differentiation 11 (25%) Submucosal invasion (pT1b) No. of patients (%) Total: 44 patients Feature

8. Pathological Characteristics Esophagectomy for pT1 adenocarcinoma Aggregate number of patients who may have been inadequately treated by EMR: 29 (66%) 2 (5%) Lymphovascular invasion 27 (61%) Multifocal carcinoma or HGD 2 (5%) Lymph node metastasis No. of patients (%) Total : 44 patients Impediments to EMR

9. Oncological Outcome Esophagectomy for pT1 Adenocarcinoma Liver 22 N0 Poor T1a Open Ivor Lewis Liver 8 N1 Poor T1b Open Ivor Lewis Nodes 6 N0 Poor T1b Lap. Trans-Hiatal Site of recurrence Time to recurrence Node status Differentiation Tumor Depth Operation