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  • Accuracy of the revised Vienna Classification for predicting postendoscopic resection outcomes for gastric and oesophageal neoplasms: a retrospective cohort study of patients from a UK tertiary referral centre

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Original research
Accuracy of the revised Vienna Classification for predicting postendoscopic resection outcomes for gastric and oesophageal neoplasms: a retrospective cohort study of patients from a UK tertiary referral centre
  1. Jen Kuan1,
  2. Elizabeth Ratcliffe2,
  3. Stephen Hayes3,
  4. Stephen McGrath3,
  5. Yeng Ang1,4
  1. 1 Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  2. 2 Gastroenterology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
  3. 3 Histopathology Department, Salford Royal NHS Foundation Trust, Salford, UK
  4. 4 Gastroenterology Department, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK
  1. Correspondence to Dr Elizabeth Ratcliffe, Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan WN1 2NN, UK; elizabeth.ratcliffe{at}WWL.nhs.uk

Abstract

Aims To review the effectiveness of the revised Vienna classification (rVC) at predicting histological outcome and defining the postendoscopic resection (ER) clinical management plan of gastro-oesophageal dysplasia and early neoplasia in a UK tertiary-centre population.

Methods This was a retrospective cohort study between November 2011 and May 2018. 157 patients from Salford Royal NHS Foundation Trust in the UK were included. The primary outcome was the histological results of postsurgical resection (SR) specimens compared with their post-ER rVC. The secondary outcome was overall survival rates of patients with category 4.4 and 5 of the rVC.

Results One-hundred and thirteen patients were diagnosed with category ≥4 of the rVC. 23 patients (20.4%) were referred for additional surgery, whereas 69 patients (61.1%) were on endoscopic surveillance only. 60.9% of post-SR specimens (14/23) revealed no residual neoplasia. 78.6% of these cancer-free specimens were classed as category 5 rVC. The overall 7-year survival rate of 25 patients with category ≥4.4 was 68% with causes of mortality not linked to upper gastrointestinal neoplasia. The overall 7-year and 3-year survival rates of category 4.4 and 5 were 73.6% and 50%, respectively, although age and comorbid state played a role.

Conclusions This study provides evidence of outcomes comparable to other reported cohorts for cases after ER in a single-centre UK population even at rVC 4.4/5. It suggests surgery may not be necessary in all cases due to the lack of residual disease and further refinement of the rVC category 5 may help guide management.

  • cancer
  • prevention
  • endoscopic resection
  • advanced endoscopy
  • revised Vienna Classification

http://dx.doi.org/10.1136/jclinpath-2019-206285

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    Footnotes

    • Handling editor Runjan Chetty.

    • Contributors JK: performed data collection, analysis and prepared an early draft of the manuscript. ER: performed further analysis of the data, was responsible for rewriting, editing and revising the manuscript after the initial draft. SH and SMcG: provided histopathology expertise during the project and writing of the manuscript. They reviewed the specimens and provided the images for figures 1 and 2. YA: conceived the project, had overall responsibility for the publication. All authors contributed to and reviewed the final drafts of the paper prior to submission.

    • Funding YA has received funding for other projects from NIHR, Cancer Research UK and Medtronic Ltd.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval As per institutional review no ethics approval was required as this study formed part of the trusts service improvement and audit.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. A deidentified participant data can be made available on request as a spreadsheet to Professor Yeng Ang Orcid 0000-0003-0496-6710. Reuse would need to be negotiated as a collaboration.