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Comparative Study
. 2009 Sep;137(3):815-23.
doi: 10.1053/j.gastro.2009.05.059. Epub 2009 Jun 12.

Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett's esophagus

Ganapathy A Prasad  1 , Tsung Teh Wu, Dennis A Wigle, Navtej S Buttar, Louis-Michel Wongkeesong, Kelly T Dunagan, Lori S Lutzke, Lynn S Borkenhagen, Kenneth K Wang
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Free PMC article
Comparative Study

Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett's esophagus

Ganapathy A Prasad et al. Gastroenterology. 2009 Sep.
Free PMC article

Abstract

Background & aims: Endoscopic therapy is emerging as an alternative to surgical therapy in patients with mucosal (T1a) esophageal adenocarcinoma (EAC) given the low likelihood of lymph node metastases. Long-term outcomes of patients treated endoscopically and surgically for mucosal EAC are unknown. We compared long-term outcomes of patients with mucosal EAC treated endoscopically and surgically.

Methods: Patients treated for mucosal EAC between 1998 and 2007 were included. Patients were divided into an endoscopically treated group (ENDO group) and a surgically treated group (SURG group). Vital status information was queried using an institutionally approved internet research and location service. Statistical analysis was performed using Kaplan-Meier curves and Cox proportional hazard ratios.

Results: A total of 178 patients were included, of whom 132 (74%) were in the ENDO group and 46 (26%) were in the SURG group. The mean follow-up period was 64 months (standard error of the mean, 4.8 mo) in the SURG group and 43 months (standard error of the mean, 2.8 mo) in the ENDO group. Cumulative mortality in the ENDO group (17%) was comparable with the SURG group (20%) (P = .75). Overall survival also was comparable using the Kaplan-Meier method. Treatment modality was not a significant predictor of survival on multivariable analysis. Recurrent carcinoma was detected in 12% of patients in the ENDO group, all successfully re-treated without impact on overall survival.

Conclusions: Overall survival in patients with mucosal EAC when treated endoscopically appears to be comparable with that of patients treated surgically. Recurrent carcinoma occurs in a limited proportion of patients, but can be managed endoscopically.

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Figures

Figure 1
Figure 1
Flowsheet of patients treated with endoscopic therapy.
Figure 2
Figure 2
Overall survival in ENDO and SURG groups (Kaplan Meier curves) Blue Line: ENDO group Red line: SURG group Log rank test p=0.15
Figure 3
Figure 3
Cancer free survival in ENDO and SURG groups (Kaplan Meier curves) Blue Line: ENDO group Red line: SURG group Log rank test p = 0.01
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Comment in

  • Reflux and Barrett's disease.
    Crockett SD, Shaheen NJ. Crockett SD, et al. Endoscopy. 2011 Jan;43(1):21-5. doi: 10.1055/s-0030-1256021. Epub 2011 Jan 13. Endoscopy. 2011. PMID: 21234837 Free PMC article. No abstract available.

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References

    1. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142–6. - PubMed

    1. Surveillance EaERSpwscg.

    1. Kelsen DP, Winter KA, Gunderson LL, Mortimer J, Estes NC, Haller DG, Ajani JA, Kocha W, Minsky BD, Roth JA, Willett CG. Long-term results of RTOG trial 8911 (USA Intergroup 113): a random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol. 2007;25:3719–25. - PubMed
    1. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37. - PubMed
    1. Chang AC, Ji H, Birkmeyer NJ, Orringer MB, Birkmeyer JD. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg. 2008;85:424–9. - PubMed

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