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, surgical removal of the esophagus.
It found that endoscopic therapy offered long-term survival rates similar to those for esophagectomy, says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic in Florida.
"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 says.
"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 changes for cure and long-term survival," he says. "Patients now have the option to preserve their esophagus when only early stage cancer is present."
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 percent) or surgery (81 percent) from 1998 through 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 percent in 1998 to 29 percent 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 to surgery.
"Endoscopy therapy for early stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer," Dr. Wallace says. He adds that because of its complexity the procedure is generally offered at centers of endoscopic excellence, such as Mayo Clinic in Florida, that have extensive experience in a multidisciplinary approach to endoscopic therapy.
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