Long-term survival and postoperative mortality evaluation in patients with stage T1 esophageal cancer undergoing esophagectomy

Abstract

Introduction: Endoscopic and surgical treatment are options in the treatment of early esophageal cancer.

Objective: To evaluate postoperative mortality and long-term survival in esophagectomy for esophageal cancer with mucosal or submucosal involvement (T1).

Materials and Methods: Retrospective cohort study based on a prospective database. All patients undergoing esophagectomy with T1 involvement between 1996 and 2023 were included. Ninety-day postoperative mortality was considered. Overall sur-vival was calculated using Kaplan-Meier curves.

Results: Sixteen patients were included (11 men, age 63 ± 10 years). Tumor location was predominantly in the middle third (63%). Histological type was 56% squamous and 44% adenocarcinoma. Esophagectomy was minimally invasive in 62%. Total postoperative morbidity was 81%, with 25% serious complications (Clavien ≥ 3). 90-day mortality was 0%. R0 resection was achieved 100%. Tumor invasion reached the mucosa (T1a) in 81% and the submucosa (T1b) in 19%. The lymph node count was 19 ± 13. No cases presented lymph node involvement. The median follow-up was 101 months. The overall 5-year survival rate was 94%, median not reached. There was no mortality associated with esophageal cancer.

Discussion and Conclusion: In this series, there was no postoperative mortality, and survival, with very long-term follow-up, exceeded 90%. However, esophagectomy was associated with high morbidity. These results should be considered when evaluating treatment options in patients with stage T1 esophageal cancer, with esophagectomy being a valid treatment option.