Endoscopic resection of esophageal squamous-cell neoplasia with curative intent appears to be an alternative treatment to radical surgery when the malignant neoplasia is intraepithelial or limited to the mucosal layer.
This is because the risk for lymph-node metastases is very low, writes Oliver Pech, lead-author of this study.
However, unlike in Japan, experience with endoscopic resection in such cases has been limited in Europe and the United States.
This study is the largest so far in Western countries, and examined patients with early squamous-cell cancer or carcinoma in situ, who were treated using endoscopic resection therapy.
The observational study was conducted between December 1997 and November 2001, when 115 patients with a suspicion of early squamous cancer were referred for local endoscopic therapy.
A total of 39 patients, with mean age 61.4 years, with early esophageal cancer (n = 29) and carcinoma in situ (Cis) (n = 10) were found to fulfill the criteria for local endoscopic therapy. These patients were then treated using endoscopic resection.
The study patients were separated into three groups. Group A composed the 10 Cis patients, group B was made up of 19 patients with mucosal cancer, and the remaining 10 patients formed group C. All patients in group C had submucosal cancer and were either inoperable or had refused surgery.
A total of 94 resections were performed.
Nine of the 10 patients in group A (90%), 19 of the 19 in group B (100%), and 8 of the 10 in group C (80%) achieved a complete response during a mean follow-up period of 29.7 ± 14.3 months.
There were three tumor-related deaths. One was a patient in group B, who was inoperable, while two were group C patients who had refused to undergo surgery.
There were no major complications such as perforation or bleeding requiring blood transfusion recorded during the study, but minor complications were seen in 6 patients (15%).
These comprised 3 patients with minor bleeding after endoscopic resection and 3 with esophageal stenoses, who were successfully treated using injection therapy or dilatation.
|90% of patients with carcinoma in situ achieved a complete response following resection|
|American Journal of Gastroenterology|
The researchers calculated 5-year survival as 90% in group A, 89% in group B and 0% in group C.
They conclude that endoscopic resection appears to be an effective and safe method of curative treatment in patients with carcinoma in situ and mucosal squamous-cell carcinomas of the esophagus.
Esophagectomy or chemoradiotherapy, whenever possible, should be the preferred method in patients with submucosal cancer, they advise.