Analysis of the Incidence of Lymph Node Metastases in High‐Risk Early Stage (T1) Esophageal Adenocarcinomas: A Single‐Institution Experience

ABSTRACT Introduction The incidence of lymph node metastasis (LNM) in early stage esophageal adenocarcinoma (EAC) is up to 45% based on high‐risk pathologic features. This risk has not been determined following external validation of staging and pathologic features. Methods Patients with clinical T1 EAC who underwent surgical resection at a single institution from 1999 to 2023 were included. Before inclusion, all retrospective data was validated by an external reviewer within the institution. Patients were categorized into low‐risk and high‐risk categories. Incidence of LNM was examined using univariate analyses. Survival analysis was performed with Kaplan Meier survival estimates. Results 66 patients underwent esophagectomy and had multidisciplinary validation of staging and pathologic data; 28 (42.4%) patients had pT1b and 11/28 (39.3%) had SM3 tumors. The LNM rate was 10.6%; the incidence of LNM was higher for T1b compared to T1a (17.9%, N = 5/28 vs 5.3%, N = 2/38, p 0.10) tumors. Low‐risk pT1a and high‐risk pT1b patients had a LNM rates of 3.3% and 21.7%, respectively. Following a median follow‐up of 46 months, there was no significant difference in overall survival and recurrence‐free survival across risk stratification groups and comparing patients with and without LNM. Sensitivity for staging of T1b tumors was poor (40.9%, 50%, and 82.1%, respectively) for chest/abdominal CT, PET/CT, and EUS. Conclusion T1 EAC patients retrospectively reviewed for multidisciplinary validation of staging and pathologic data have a LNM risk up to 21.7% when stratified by risk factors with a clinical trend toward worse survival. High‐risk T1b patients may warrant neoadjuvant chemoradiotherapy before surgical resection.