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Endoscopic treatment vs surgery for the survival of esophageal cancer

November's issue of the Clinical Gastroenterology & Hepatology examines the survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery.

News image

Endoscopic therapy can improve long-term outcomes of patients with superficial esophageal adenocarcinoma, producing fewer complications than esophagectomy.

However, there have been few population-based studies to compare long-term outcomes of patients who received these treatments.

Dr Michael Wallace and colleagues from Florida, USA used a large national cancer database to evaluate the outcomes of patients with superficial esophageal adenocarcinoma who underwent endoscopic therapy or surgery.

The research team used the Surveillance Epidemiology and End Results database to identify 1618 patients with Tis or T1 N0M0 esophageal adenocarcinoma from 1998–2009.

Patients were grouped on the basis of whether they received endoscopic therapy or surgery.

Multivariate logistic regression was performed to identify factors associated with endoscopic therapy.

The researchers collected survival data through the end of 2009.

Overall survival after 5 years was higher in the surgery group
Clinical Gastroenterology & Hepatology

Overall survival and esophageal cancer–specific survival were compared after controlling for relevant covariates.

The researchers observed that the use of endoscopic therapy increased progressively from 3% in 1998 to 29% in 2009.

The team noted that factors associated with use of endoscopic therapy included age older than 65 years, diagnosis in 2006−2009 vs 1998−2001, and the absence of submucosal invasion.

The research team noted that overall survival after 5 years was higher in the surgery group than in the endoscopic therapy group.

After adjusting for patient and tumor factors, patients treated by endoscopy had similar overall survival times, and esophageal cancer–specific survival times.

Dr Wallace's team concluded, "In a population-based analysis, the use of endoscopic therapy for superficial esophageal adenocarcinoma tended to increase from 1998–2009."

"Long-term survival of patients with esophageal adenocarcinoma did not appear to differ between those who received endoscopic therapy and those treated with surgery."

Clin Gastroenterol Hepatol 2013: 11(11): 1424-1429.e2
30 October 2013

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