Survival better with surgical resection than with endoscopic resection for early esophageal cancer

A study sheds new light on the risks associated with the growing popularity of endoscopic resection in the treatment of localized, early stage esophageal cancer. Researchers found that the more traditional surgical resection, while more invasive, provided significantly better outcomes (5-year survival rate 87.6%) for patients than endoscopic resection (5-year survival rate 76%).

Endoscopic esophageal resection uses an endoscope, a flexible tube equipped with a small camera, which can be guided to very specific locations within the GI tract with little or no disruption to the rest of the body. Esophageal surgical resection is used to remove a section of a patient's esophagus, and the digestive tract is then reconstructed by reconnecting the remaining unaffected sections.

"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 senior author 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 in Chicago, Illinois. "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."

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 closer to the surface and less mature than those classified as T1b. The study's authors also state that most likely due to these differences, they also found that roughly 1 in 5 T1b cancers had spread to at least one lymph node, whereas only 1 in 20 T1a cancers had done the same. The study was published in the Journal of the National Cancer Institute (2014; doi:10.1093/jnci/dju133).

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