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01-07-2019

Comparison of the short-term and long-term outcomes of surgical treatment versus endoscopic treatment for early esophageal squamous cell neoplasia larger than 2 cm: a retrospective study

Authors: Baisi Yuan, Leilei Liu, Hairong Huang, Demin Li, Yi Shen, Bo Wu, Jiong Liu, Miaofang Yang, Zhenkai Wang, Heng Lu, Yuxiu Liu, Lianming Liao, Fangyu Wang

Published in: Surgical Endoscopy | Issue 7/2019

Abstract

Background

NCCN Guidelines of esophageal cancer recommend that endoscopic therapy is considered “preferred” for patients with limited early-stage disease less than or equal to 2 cm. However, there is currently no definite evidence to support either endoscopic therapy or esophagectomy for early esophageal cancer larger than 2 cm. We aimed to explore the optimal treatment for this condition.

Methods

From January 2010 to June 2016, 116 patients with early esophageal neoplasia [high-grade dysplasia (HGD), lamina propria and muscularis mucosae (T1a) cancer, selected superficial submucosa (T1b) cancer without lymph node metastases] larger than 2 cm and treated either surgically or endoscopically were included.

Results

Endoscopic therapy was performed in 69 patients and esophagectomy in 47 patients, respectively. The median follow-up time was 43.8 months in the endoscopic cohort and 49.4 months in the surgical cohort. The overall survival was similar between the two cohorts (97.1% vs. 91.5%, P = 0.18). Survival without readmission for treatment-related complicates was also similar. Minor and severe procedure-related complications occurred more often in the surgical cohort than in the endoscopic cohort (63.8% vs. 43.5% and 8.5% vs. 0 respectively, P < 0.05 for both). Four patients in the endoscopic cohort had to undergo additional esophagectomy and were alive during follow-up. There were no procedure-related deaths in the endoscopic cohort, whereas two deaths occurred in the surgical cohort. Recurrence occurred in nine patients in the endoscopic group (13%): six with local recurrence, one with residual neoplasia and two with metachronous neoplasia. None of them died after repeated endoscopic treatments.

Conclusions

Efficacy was similar between endoscopic therapy and esophagectomy in the treatment of early esophageal squamous cell neoplasia larger than 2 cm and endoscopic therapy was associated with fewer and manageable complications. We recommend endoscopic treatment should be preferred selected for early esophageal neoplasia larger than 2 cm.

Eloubeidi MA, Mason AC, Desmond RA, El-Serag HB (2003) Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol 98(7):1627–1633PubMed

ASGE Standards of Practice Committee, Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jue TL, Pasha SF, Sharaf R, Shergill AK, Dominitz JA, Cash BD, American Society for Gastrointestinal Endoscopy (2013) The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 77(3):328–334. https://doi.org/10.1016/j.gie.2012.10.001 CrossRef

Prasad GA, Wu TT, Wigle DA, Buttar NS, Wongkeesong LM, Dunagan KT, Lutzke LS, Borkenhagen LS, Wang KK (2009) Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 137(3):815–823. https://doi.org/10.1053/j.gastro.2009.05.059.CrossRefPubMed

Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206. https://doi.org/10.1136/gut.2007.142539 CrossRefPubMed

Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65(1):3–10CrossRefPubMed

Chennat J, Konda VJ, Ross AS, de Tejada AH, Noffsinger A, Hart J, Lin S, Ferguson MK, Posner MC, Waxman I (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma: an American single-center experience. Am J Gastroenterol 104(11):2684–2692. https://doi.org/10.1038/ajg.2009.465 CrossRefPubMed

Peters FP, Kara MA, Rosmolen WD, ten Kate FJ, Krishnadath KK, van Lanschot JJ, Fockens P, Bergman JJ (2006) Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol 101(7):1449–1457CrossRefPubMed

Wang Z, Lu H, Wu L, Yuan B, Liu J, Shi H, Wang F (2016) Long-term outcomes of endoscopic multiband mucosectomy for early esophageal squamous cell neoplasia: a retrospective, single-center study. Gastrointest Endosc 84(6):893–899. https://doi.org/10.1016/j.gie.2016.04.015 CrossRefPubMed

Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Hölscher AH (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254(1):67–72. https://doi.org/10.1097/SLA.0b013e31821d4bf6 CrossRefPubMed

10.

Ngamruengphong S, Wolfsen HC, Wallace MB (2013) Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clin Gastroenterol Hepatol 11(11):1424–1429. https://doi.org/10.1016/j.cgh.2013.05.025 CrossRefPubMedPubMedCentral

11.

Wani S, Drahos J, Cook MB, Rastogi A, Bansal A, Yen R, Sharma P, Das A (2014) Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc 79(2):224–232.e1. https://doi.org/10.1016/j.gie.2013.08.002 CrossRefPubMed

12.

Gockel I, Sgourakis G, Lyros O, Polotzek U, Schimanski CC, Lang H, Hoppo T, Jobe BA (2011) Risk of lymph node metastasis in submucosal esophageal cancer: a review of surgically resected patients. Expert Rev Gastroenterol Hepatol 5(3):371–384. https://doi.org/10.1586/egh.11.33 CrossRefPubMed

13.

Moraca RJ, Low DE (2006) Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg 141(6):545–549CrossRefPubMed

14.

NCCN Clinical practice guidelines in oncology. Esophageal and esophagogastric junction cancers, version 4, 2017. http://oncolife.com.ua/doc/nccn/Esophageal_and_Esophagogastric_Junction_Cancers.pdf

15.

Thota PN, Sada A, Sanaka MR, Jang S, Lopez R, Goldblum JR, Liu X, Dumot JA, Vargo J, Zuccarro G (2017) Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett’s esophagus with high-grade dysplasia and early cancer. Surg Endosc 31(3):1336–1341CrossRefPubMed

16.

Bergeron EJ, Lin J, Chang AC, Orringer MB, Reddy RM (2014) Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg 147(2):765–771CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

18.

Das A, Singh V, Fleischer DE, Sharma VK (2008) A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data. Am J Gastroenterol 103(6):1340–1345. https://doi.org/10.1111/j.1572-0241.2008.01889.x CrossRefPubMed

19.

Fujita H, Sueyoshi S, Yamana H, Shinozaki K, Toh U, Tanaka Y, Mine T, Kubota M, Shirouzu K, Toyonaga A, Harada H, Ban S, Watanabe M, Toda Y, Tabuchi E, Hayabuchi N, Inutsuka H (2001) Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy. World J Surg 25(4):424–431CrossRefPubMed

20.

Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, Lutzke LS, Borkenhagen LS (2007) Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 132(4):1226–1233CrossRefPubMedPubMedCentral

21.

Schembre DB, Huang JL, Lin OS, Cantone N, Low DE (2008) Treatment of Barrett’s esophagus with early neoplasia: a comparison of endoscopic therapy and esophagectomy. Gastrointest Endosc 67(4):595–601. https://doi.org/10.1016/j.gie.2007.08.042 CrossRefPubMed

22.

Rosmolen WD, Boer KR, de Leeuw RJ, Gamel CJ, van Berge Henegouwen MI, Bergman JJ, Sprangers MA (2010) Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett’s esophagus. Endoscopy 42(7):525–531. https://doi.org/10.1055/s-0029-1244222 CrossRef

23.

Cummings LC, Kou TD, Schluchter MD, Chak A, Cooper GS (2016) Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population. Gastrointest Endosc 84(2):232–240.e1. https://doi.org/10.1016/j.gie.2016.01.019 CrossRefPubMedPubMedCentral

24.

Bustamante FA, Hourneaux DE, Moura EG, Bernardo W, Sallum RA, Ide E, Baba E (2016) Surgery versus endoscopic therapies for early cancer and high-grade dysplasia in the esophagus: a systematic review. Arq Gastroenterol 53(1):10–19. https://doi.org/10.1590/S0004-28032016000100004 CrossRefPubMed

25.

Hollis AC, Quinn LM, Hodson J, Evans E, Plowright J, Begum R, Mitchell H, Hallissey MT, Whiting JL, Griffiths EA (2017) Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer. J Surg Oncol 116(8):1114–1122CrossRefPubMed

26.

Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ (2014) Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. https://doi.org/10.1093/jnci/dju133 CrossRefPubMed

27.

Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS (2003) Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol 1(4):252–257CrossRefPubMed

28.

Reed MF, Tolis G Jr, Edil BH, Allan JS, Donahue DM, Gaissert HA, Moncure AC, Wain JC, Wright CD, Mathisen DJ (2005) Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 79(4):1110–1115CrossRefPubMed

29.

Hulscher F, van Sandick J, de Boer A, Wijnhoven B, Tijssen J, Fockens P (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669CrossRef

30.

Jamieson G, Mathew G, Ludemann R, Wayman J, Myers J, Devitt P (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 5(8):943–947CrossRef

31.

Mohiuddin K, Dorer R, El Lakis MA, Hahn H, Speicher J, Hubka M, Low DE (2016) Outcomes of surgical resection of T1bN0 esophageal cancer and assessment of endoscopic mucosal resection for identifying low-risk cancers appropriate for endoscopic therapy. Ann Surg Oncol 23(8):2673–2678CrossRefPubMed

32.

Wang S, Huang Y, Xie J, Zhuge L, Shao L, Xiang J, Zhang Y, Sun Y, Hu H, Chen S, Lerut T, Luketich JD, Zhang J, Chen H (2018) Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis. Surg Endosc 32(3):1441–1448CrossRefPubMed

33.

Smith I, Kahaleh M (2015) Endoscopic versus surgical therapy for Barrett’s esophagus neoplasia. Expert Rev Gastroenterol Hepatol 9(1):31–35CrossRefPubMed

34.

Kawaguchi G, Sasamoto R, Abe E, Ohta A, Sato H, Tanaka K, Maruyama K, Kaizu M, Ayukawa F, Yamana N, Liu J, Takeuchi M, Kobayashi M, Aoyama H (2015) The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol 10:31. https://doi.org/10.1186/s13014-015-0337-4 CrossRefPubMedPubMedCentral

35.

Mariette C, Finzi L, Piessen G, Van Seuningen I, Triboulet JP (2005) Esophageal carcinoma: prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg 29(1):39–45CrossRefPubMed

36.

Arnold M, Soerjomataram I, Ferlay J, Forman D (2015) Global incidence of oesophageal cancer by histological subtype in 2012. Gut 64(3):381–387. https://doi.org/10.1136/gutjnl-2014-308124 CrossRef

37.

Martínek J, Juhas S, Dolezel R, Walterová B, Juhasova J, Klima J, Rabekova Z, Vacková Z (2018) Prevention of esophageal strictures after circumferential endoscopic submucosal dissection. Minerva Chir 73(4):394–409. https://doi.org/10.23736/S0026-4733.18.07751-9 CrossRefPubMed

Title: Comparison of the short-term and long-term outcomes of surgical treatment versus endoscopic treatment for early esophageal squamous cell neoplasia larger than 2 cm: a retrospective study
Authors: Baisi Yuan
Leilei Liu
Hairong Huang
Demin Li
Yi Shen
Bo Wu
Jiong Liu
Miaofang Yang
Zhenkai Wang
Heng Lu
Yuxiu Liu
Lianming Liao
Fangyu Wang
Publication date: 01-07-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6524-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of the short-term and long-term outcomes of surgical treatment versus endoscopic treatment for early esophageal squamous cell neoplasia larger than 2 cm: a retrospective study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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