A minimally invasive endoscopic procedure to remove superficial, early stage esophageal is as effective as surgery that removes the entire esophagus, according to the results of a study published in Clinical Gastroenterology and Hepatology.
The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 17,000 people are diagnosed with esophageal cancer and more than 15,000 die of the disease.
Treatment of esophageal cancer often involves esophagectomy, a major surgical procedure, in which a surgeon removes the entire esophagus and then rebuilds it by pulling the stomach into the neck to create a new food tube. The procedure carries the risk of pulmonary (lung) complications.
A newer procedure relies on endoscopy, which involves several tiny incisions and the use of a camera to see inside the body. The procedure is more technically complex, but less invasive. Endoscopy results in fewer complications, but there is little data comparing long-term outcomes of endoscopy and esophagectomy.
Researchers used data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database to identify 1,618 patients with superficial, early stage esophageal cancer who had endoscopic therapy or esophagectomy between 1998 and 2009. Many of these patients were treated for cancers that arose from Barrett’s esophagus, a precancerous condition.
Overall, 19 percent of patients were treated with endoscopy and 81 percent with esophagectomy. The use of endoscopy increased from 3 percent in 1998 to 29 percent in 2009. The procedure was most often used in older patients. Overall survival after five years was higher in the esophagectomy group (70 percent) compared with the endoscopy group (58 percent). However, after adjusting for patient and tumor factors, the researchers found that patients treated with endoscopy had similar overall survival times compared with those treated with surgery.
The researchers concluded that endoscopic therapy and esophagectomy appeared to produce similar long-term survival outcomes in patients with superficial, early stage esophageal cancer.
Ngamruengphong S, Wolfsen HC, Wallace MB. Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clinical Gastroenterology and Hepatology. 2013; 11(11): 1424-1429.e2.