Open AccessPredicting lymph node metastases with endoscopic resection in cT2N0M0 oesophageal cancer: A systematic review and meta‐analysis
Author(s) -
AlKaabi Ali,
Post Rachel S,
Huising Jonathan,
Rosman Camiel,
Nagtegaal Iris D,
Siersema Peter D
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640619879007
Subject(s) - medicine , lymph node , meta analysis , lymphovascular invasion , stage (stratigraphy) , radiology , cancer , lymph , pathological , systematic review , cancer staging , surgery , metastasis , medline , pathology , paleontology , biology , political science , law
Background Despite modern imaging modalities, staging of clinically staged T2N0M0 (cT2N0M0) oesophageal cancer is suboptimal, often leading to overtreatment. Endoscopic resection – the first‐line therapy for early localised tumours – could be used to improve staging and to attain predictors of nodal upstaging enabling more stage‐guided treatment decisions. Objective A systematic literature review and a meta‐analysis were conducted to assess the prevalence and the pathological risk factors of lymph node metastases in cT2N0M0 oesophageal cancer. Methods Databases of PUBMED, EMBASE and Cochrane were searched for literature. The primary outcome was lymph node metastases determined after primary surgical resection. Results Nine studies with a total of 1650 cT2N0M0 patients were included. The prevalence of lymph node metastases was 43% (95% confidence interval: 35–50%) with heterogeneity being high across studies ( I 2 = 0.86, p < 0.001). Factors potentially attainable by endoscopic resection and having a significant association with lymph node metastases were invasion depth, differentiation grade, tumour size, depth of invasion in the muscularis propria and lymphovascular invasion. Conclusions Clinical lymph node staging is inaccurate in almost half of cT2N0M0 oesophageal cancer. Endoscopic resection is a promising diagnostic modality that might even be a valid alternative to surgery in selected patients without high‐risk features, but further evidence is warranted.