Less-invasive option effective in early esophageal cancer

Use of a minimally invasive endoscopic procedure to remove superficial, early-stage esophageal cancer is as effective as surgery that removes and rebuilds the esophagus, according to a new study. The study examined national outcomes from endoscopic treatment and from esophagectomy, which is surgical removal of the esophagus.

Endoscopic therapy was found to offer long-term survival rates similar to those for esophagectomy, according to lead author Michael B. Wallace, MD, of the Mayo Clinic in Jacksonville, Florida. He said, “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.”

The research looked at national outcomes from the two procedures in patients with esophageal adenocarcinoma, the most common type of esophageal cancer in the United States. The research team examined data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.

They identified 1,619 patients with superficial, early-stage esophageal adenocarcinoma who had endoscopic therapy (19%) or surgery (81%) between 1998 and 2009. Many of these patients were treated for cancers that arose from Barrett's esophagus, a condition in which the cells in the lower part of the esophagus morph into a precancerous state.

The researchers collected survival data through the end of 2009, and found that endoscopy therapy increased progressively—from 3% in 1998 to 29% in 2009—and was more often used in older patients. After adjusting for patient and tumor factors, the researchers concluded that patients treated by endoscopy had similar overall survival times compared with surgery.

“Endoscopy therapy for early-stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer,” Wallace said. He added that, because of its complexity, the procedure is generally offered at centers of endoscopic excellence, such as the Mayo Clinic in Florida, that have extensive experience in a multidisciplinary approach to endoscopic therapy.

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