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Endoscopic treatment for mucosal esophageal adenocarcinoma represents reasonable alternative to surgery, findings suggest

Wednesday, September 09 2009 | Comments

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What's This? Among patients with mucosal esophageal adenocarcinoma (EAC), endoscopic treatment yields an overall survival rate comparable to that observed following esophagectomy, according to data from a retrospective cohort study. The findings also suggest that recurrence following endoscopic mucosal resection occurs in a limited proportion of patients and can be managed endoscopically.

To compare long-term outcomes following endoscopic and surgical approaches to the treatment of mucosal (stage T1a) EAC, researchers evaluated data for 178 patients who were treated at the Mayo Clinic in Rochester, Minnesota, between 1998 and 2007. Of these patients, 74% underwent endoscopic mucosal resection with or without photodynamic therapy and 26% underwent esophagectomy.

The mean follow-up was 64 months in the surgery group (approximately 244 person-years) and 43 months in the endoscopy group (approximately 464.5 person-years).

The cumulative mortality rate was 17% in the endoscopy group and 20% in the surgery group (P=.75).

In an analysis adjusted for age, sex, length of Barrett's esophagus segment, Charlson comorbidity score, and propensity score (a score predicting the probability of being assigned to the endoscopy group), overall survival was comparable between the endoscopy and surgery groups (hazard ratio [HR], 1.54 [95% CI, 0.64-3.75]; P=.33).

Cancer-free survival was better in the surgery group (HR, 2.64 [95% CI, 1.70-4.08]; P<.001) because of a higher rate of recurrent carcinoma in the endoscopy group (16 patients [12%] vs 1 patient [2%]). The incidence rate ratio for recurrence was 9.8 in the endoscopy group as compared with the surgery group.

However, the investigators noted, all cases of recurrence in the endoscopy group were successfully retreated with no effect on overall survival. Fifteen of the 16 cases were retreated endoscopically; the remaining patient chose to undergo esophagectomy, which revealed a residual microscopic focus of intramucosal carcinoma without metastatic lymphadenopathy. (Prasad GA, et al. Gastroenterology 2009;137:815-823.)

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