Study Helps Compare Risks of Endoscopic vs Surgical Resection for Early Esophageal Cancer
A new study published in the Journal of the National Cancer Institute by researchers at Northwestern Medicine shed new light on the risks associated with the growing popularity of endoscopic resection in the treatment of localized, early-stage esophageal cancer. Merkow et al found that the more traditional surgical resection, while more invasive, provided significantly better 5-year conditional survival outcomes than endoscopic resection.
“Endoscopic resection was becoming a more and more common surgical choice for treating early-stage esophageal cancer, but there really wasn’t a single large study with evidence to suggest it was the best choice,” said the senior author of the study, David J. Bentrem, MD, Director of the Gastrointestinal Oncology Lab at Northwestern Memorial Hospital and Method Professor of Surgical Research for the Northwestern University Feinberg School of Medicine. “This study sheds some much needed light on the issue and will hopefully encourage physicians and patients to more closely examine whether or not endoscopic resection is the best course of treatment.”
Study Details
The study reviewed the outcomes of more than 5,000 patients from 824 hospitals using the National Cancer Data Base, a program of the American College of Surgeons Commission on Cancer and the American Cancer Society. Of these patients, 26.5% underwent endoscopic resection and 73.5% underwent surgical resection.
The risk for all-cause 30-day mortality was lower after endoscopic resection vs surgical resection (0.5% vs 3.5%). However, patients selected for endoscopic resection had a 5-year conditional survival rate of 76.5%, compared to 87.6% for patients who underwent traditional surgical resection.
In addition to reviewing survival rates, the study found that despite the lack of strong evidence-based research to promote a growing use of endoscopic esophageal resection, the procedure increased from 19% in 2004 to 53% in 2010 for T1a cancers and from 6.6% in 2004 to 20.9% in 2010 for T1b cancers. While both stages of esophageal cancer involve tumors that are close to the surface and relatively small, T1a esophageal tumors are the closer to the surface and less mature than those classified as T1b. The study’s authors also stated that most likely due to these differences, they also found that 16.6% of T1b cancers had spread to at least one lymph node, whereas only 5% T1a cancers had done the same.
Implications
“We know that for most patients with precancerous changes in the esophagus, endoscopy is the appropriate choice,” said coauthor Rajesh N. Keswani, MD, a Northwestern Medicine interventional gastroenterologist and Assistant Professor at the Feinberg School. “Our study suggests that patients with low-risk T1a cancer can also be treated appropriately and safely with endoscopic resection when performed by a skilled endoscopist. However it also provides strong evidence that endoscopic treatment should only be offered to patients with more unfavorable T1b tumors that are likely to have spread when surgical resection is not a safe option.”
“This is the largest study to date to compare endoscopic and surgical treatments for localized, early-stage esophageal cancer, and it helps compare the effectiveness of these two treatments,” said coauthor Karl Y. Bilimoria, MD, MS, a Northwestern Medicine surgical oncologist and Director of the Surgical Outcomes and Quality Improvement Center at the Feinberg School. “Our findings make it clear that that physicians should only offer endoscopic resection to a patient following a discussion about their specific case between an expert endoscopist, surgeon, pathologist, and oncologist to make sure it really is the best treatment option.”
Dr. Merkow is the corresponding author for the Journal of the National Cancer Institute article.
The study was funded by the Northwestern University Robert H. Lurie Comprehensive Cancer Center’s Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, an initiative of the William W. Wirtz cancer innovation fund.
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®.
