Less-Invasive Endoscopic Therapy as Effective as Esophagectomy in Early Esophageal Cancer
Use of a minimally invasive endoscopic procedure to remove superficial, early-stage esophageal cancer is as effective as surgery that takes out and rebuilds the esophagus, according to a study by researchers at Mayo Clinic in Florida. The research, published in Clinical Gastroenterology and Hepatology, examined national outcomes from endoscopic treatment compared to esophagectomy.
It found that endoscopic therapy offered long-term survival rates similar to those for esophagectomy, said lead author Michael B. Wallace, MD, a gastroenterologist at Mayo Clinic.
"Endoscopic resection in the esophagus is similar to how we remove polyps in the colon, although it is much more technically complex. Esophagectomy is a major surgical procedure that cuts out the entire esophagus, and pulls the stomach into the neck to create a new food tube," Dr. Wallace explained.
"Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic in Florida, suggests that both offer the similar chances for cure and long-term survival," he said. "Patients now have the option to preserve their esophagus when only early-stage cancer is present."
Study Details
Using the the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database, the researchers looked at national outcomes from the two procedures in patients with esophageal adenocarcinoma and identified 1,619 patients with superficial, early-stage esophageal adenocarcinoma who had endoscopic therapy (19%) or surgery (81%) from 1998 through 2009. Many of these patients were treated for cancers that arose from Barrett's esophagus.
The researchers collected survival data through the end of 2009, and found that endoscopic therapy increased progressively—from 3% in 1998 to 29% in 2009—and was more often used in older patients. Patients in the surgery group had higher 5-year overall survival than in the endoscopic therapy group (70% vs 58%, respectively). However, after adjusting for patient and tumor factors, the researchers concluded that patients treated by endoscopy had similar overall survival times (hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 0.92–1.58) and esophageal cancer–specific survival times (HR = 0.74, 95% CI = 0.49–1.11) compared to surgery.
"Endoscopic therapy for early-stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer," Dr. Wallace said.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
