Esophageal cancer (EC) is a significant global health burden, early disease management has witnessed substantial advancements in recent years. While surgical resection remains the cornerstone, emerging organ-preserving methods-including endoscopic resection (ER), definitive chemoradiotherapy (dCRT), and adjuvant therapies-are becoming viable alternatives for pT1a-m3/pT1b EC. This review critically evaluates contemporary diagnostic methods and emphasizes the critical role of advanced endoscopic techniques, such as Narrowband Imaging Magnifying Endoscopy (ME-NBI) in overcoming the challenge of sufficient recording for accurate TN staging. We systematically evaluated the treatment options for T1 lesions and compared the differences in survival outcomes, complications, and quality of life impact between ER, surgery, and chemoradiotherapy (CRT). Particular attention is given to the risk stratification of lymph node metastasis (LNM) and its impact on treatment selection. This review establishes an evidence-based risk stratification framework for LNM, informing clinical decision-making. ER is recommended for high-risk patients, while ER-CRT is an effective option for patients with lower recurrence risk. ER shows non-inferior survival to surgery with better functional outcomes (5-yr OS 90% vs 87%), while CRT provides organ preservation at higher stenosis risk (33%), per JCOG0502 and NCCN guidelines. By integrating data from key trials and current guidelines, this work clarifies ongoing controversies while highlighting emerging directions, including artificial intelligence(AI) enhanced endoscopic diagnosis and optimized adjuvant therapy. This analysis provides a comprehensive, evidence-based perspective for the rapidly developing field of gastrointestinal oncology.
Liu et al. (Tue,) studied this question.