Sparing the Knife for Esophageal Cancer

Esophageal cancer endoscopy therapy offered similar survival as surgery

(RxWiki News) Esophageal cancer starts in the esophagus — the 10-inch tube that connects the throat with the stomach. Surgery to remove the esophagus has been the standard treatment for early esophageal cancer. But that's changing.

A new study has shown a minimally invasive procedure that uses a tool called an endoscope was effective in removing early stage esophageal cancer.

The researchers found that esophageal cancer patients who underwent endoscopic therapy lived about as long as those whose entire esophagus had been removed.

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Michael B. Wallace, MD, a gastroenterologist at Mayo Clinic in Florida, was the lead author of this study that compared survival rate differences between esophageal cancer patients who had undergone surgery, a procedure known as an esophagectomy, and those who had received endoscopic therapy.

"Endoscopic resection in the esophagus is similar to how we remove polyps in the colon, although it is much more technically complex,” Dr. Wallace said in a statement. “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 team analyzed data from the Surveillance, Epidemiology and End Results (SEER) database on 1,619 patients with esophageal adenocarcinoma (EAC), the most common form of esophageal cancer.

This form of cancer often arises from Barrett’s esophagus, a condition in which cells in the lower esophagus evolve into a precancerous state.

Endoscopic therapy (ET) was used for 19 percent of EAC patients, while 81 percent of patients had traditional surgery between 1998 and 2009.

ET was used more often in older patients and those whose disease had not spread to connective tissue below the mucous membrane of the esophagus. Surgery was more commonly used in men, patients with tumors larger than 1.5 cm and in cancers that did not look much like normal cells (poorly differentiated).

The overall five-year survival (death from any cause) rate was 70 percent among those who had surgery and 58 percent for those who had ET.

When the researchers adjusted for various patient and tumor characteristics, overall survival was similar among both groups.

Five-year cancer-specific survival (death from EAC) was similar as well — 82 percent in the ET group and 78 percent in the surgery group.

The study reported that use of ET has been on the rise, going from 3 percent in 1998 to 29 percent in 2009.

"Endoscopy therapy for early stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer," Dr. Wallace said.

This study was published in the journal Clinical Gastroenterology and Hepatology.

The National Institutes of Health supported the research. None of the authors reported any potential conflicts of interest.

Review Date: 
November 11, 2013