Surgical Endoscopy

, Volume 33, Issue 7, pp 2304–2312 | Cite as

Comparison of the short-term and long-term outcomes of surgical treatment versus endoscopic treatment for early esophageal squamous cell neoplasia larger than 2 cm: a retrospective study

  • Baisi Yuan
  • Leilei Liu
  • Hairong Huang
  • Demin Li
  • Yi Shen
  • Bo Wu
  • Jiong Liu
  • Miaofang Yang
  • Zhenkai Wang
  • Heng Lu
  • Yuxiu Liu
  • Lianming LiaoEmail author
  • Fangyu WangEmail author



NCCN Guidelines of esophageal cancer recommend that endoscopic therapy is considered “preferred” for patients with limited early-stage disease less than or equal to 2 cm. However, there is currently no definite evidence to support either endoscopic therapy or esophagectomy for early esophageal cancer larger than 2 cm. We aimed to explore the optimal treatment for this condition.


From January 2010 to June 2016, 116 patients with early esophageal neoplasia [high-grade dysplasia (HGD), lamina propria and muscularis mucosae (T1a) cancer, selected superficial submucosa (T1b) cancer without lymph node metastases] larger than 2 cm and treated either surgically or endoscopically were included.


Endoscopic therapy was performed in 69 patients and esophagectomy in 47 patients, respectively. The median follow-up time was 43.8 months in the endoscopic cohort and 49.4 months in the surgical cohort. The overall survival was similar between the two cohorts (97.1% vs. 91.5%, P = 0.18). Survival without readmission for treatment-related complicates was also similar. Minor and severe procedure-related complications occurred more often in the surgical cohort than in the endoscopic cohort (63.8% vs. 43.5% and 8.5% vs. 0 respectively, P < 0.05 for both). Four patients in the endoscopic cohort had to undergo additional esophagectomy and were alive during follow-up. There were no procedure-related deaths in the endoscopic cohort, whereas two deaths occurred in the surgical cohort. Recurrence occurred in nine patients in the endoscopic group (13%): six with local recurrence, one with residual neoplasia and two with metachronous neoplasia. None of them died after repeated endoscopic treatments.


Efficacy was similar between endoscopic therapy and esophagectomy in the treatment of early esophageal squamous cell neoplasia larger than 2 cm and endoscopic therapy was associated with fewer and manageable complications. We recommend endoscopic treatment should be preferred selected for early esophageal neoplasia larger than 2 cm.


Esophagus Endoscopic therapy Esophagectomy Early esophageal cancer Esophageal dysphagia Esophageal squamous cell neoplasia 


Compliance with ethical standards


Drs. Baisi Yuan, Leilei Liu, Hairong Huang, Demin Li, Yi Shen, Bo Wu, Jiong Liu, Miaofang Yang, Zhenkai Wang and Heng Lu, Professor Yuxiu Liu, Lianming Liao and Fangyu Wang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Eloubeidi MA, Mason AC, Desmond RA, El-Serag HB (2003) Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol 98(7):1627–1633Google Scholar
  2. 2.
    ASGE Standards of Practice Committee, Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jue TL, Pasha SF, Sharaf R, Shergill AK, Dominitz JA, Cash BD, American Society for Gastrointestinal Endoscopy (2013) The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 77(3):328–334. CrossRefGoogle Scholar
  3. 3.
    Prasad GA, Wu TT, Wigle DA, Buttar NS, Wongkeesong LM, Dunagan KT, Lutzke LS, Borkenhagen LS, Wang KK (2009) Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 137(3):815–823. Scholar
  4. 4.
    Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T, Manner H, Guenter E, Huijsmans J, Vieth M, Stolte M, Ell C (2008) Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 57(9):1200–1206. CrossRefGoogle Scholar
  5. 5.
    Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, Nachbar L, Huijsmans J, Vieth M, Stolte M (2007) Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 65(1):3–10CrossRefGoogle Scholar
  6. 6.
    Chennat J, Konda VJ, Ross AS, de Tejada AH, Noffsinger A, Hart J, Lin S, Ferguson MK, Posner MC, Waxman I (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma: an American single-center experience. Am J Gastroenterol 104(11):2684–2692. CrossRefGoogle Scholar
  7. 7.
    Peters FP, Kara MA, Rosmolen WD, ten Kate FJ, Krishnadath KK, van Lanschot JJ, Fockens P, Bergman JJ (2006) Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol 101(7):1449–1457CrossRefGoogle Scholar
  8. 8.
    Wang Z, Lu H, Wu L, Yuan B, Liu J, Shi H, Wang F (2016) Long-term outcomes of endoscopic multiband mucosectomy for early esophageal squamous cell neoplasia: a retrospective, single-center study. Gastrointest Endosc 84(6):893–899. CrossRefGoogle Scholar
  9. 9.
    Pech O, Bollschweiler E, Manner H, Leers J, Ell C, Hölscher AH (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254(1):67–72. CrossRefGoogle Scholar
  10. 10.
    Ngamruengphong S, Wolfsen HC, Wallace MB (2013) Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clin Gastroenterol Hepatol 11(11):1424–1429. CrossRefGoogle Scholar
  11. 11.
    Wani S, Drahos J, Cook MB, Rastogi A, Bansal A, Yen R, Sharma P, Das A (2014) Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc 79(2):224–232.e1. CrossRefGoogle Scholar
  12. 12.
    Gockel I, Sgourakis G, Lyros O, Polotzek U, Schimanski CC, Lang H, Hoppo T, Jobe BA (2011) Risk of lymph node metastasis in submucosal esophageal cancer: a review of surgically resected patients. Expert Rev Gastroenterol Hepatol 5(3):371–384. CrossRefGoogle Scholar
  13. 13.
    Moraca RJ, Low DE (2006) Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg 141(6):545–549CrossRefGoogle Scholar
  14. 14.
    NCCN Clinical practice guidelines in oncology. Esophageal and esophagogastric junction cancers, version 4, 2017.
  15. 15.
    Thota PN, Sada A, Sanaka MR, Jang S, Lopez R, Goldblum JR, Liu X, Dumot JA, Vargo J, Zuccarro G (2017) Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett’s esophagus with high-grade dysplasia and early cancer. Surg Endosc 31(3):1336–1341CrossRefGoogle Scholar
  16. 16.
    Bergeron EJ, Lin J, Chang AC, Orringer MB, Reddy RM (2014) Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg 147(2):765–771CrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  18. 18.
    Das A, Singh V, Fleischer DE, Sharma VK (2008) A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data. Am J Gastroenterol 103(6):1340–1345. CrossRefGoogle Scholar
  19. 19.
    Fujita H, Sueyoshi S, Yamana H, Shinozaki K, Toh U, Tanaka Y, Mine T, Kubota M, Shirouzu K, Toyonaga A, Harada H, Ban S, Watanabe M, Toda Y, Tabuchi E, Hayabuchi N, Inutsuka H (2001) Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy. World J Surg 25(4):424–431CrossRefGoogle Scholar
  20. 20.
    Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, Lutzke LS, Borkenhagen LS (2007) Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 132(4):1226–1233CrossRefGoogle Scholar
  21. 21.
    Schembre DB, Huang JL, Lin OS, Cantone N, Low DE (2008) Treatment of Barrett’s esophagus with early neoplasia: a comparison of endoscopic therapy and esophagectomy. Gastrointest Endosc 67(4):595–601. CrossRefGoogle Scholar
  22. 22.
    Rosmolen WD, Boer KR, de Leeuw RJ, Gamel CJ, van Berge Henegouwen MI, Bergman JJ, Sprangers MA (2010) Quality of life and fear of cancer recurrence after endoscopic and surgical treatment for early neoplasia in Barrett’s esophagus. Endoscopy 42(7):525–531. CrossRefGoogle Scholar
  23. 23.
    Cummings LC, Kou TD, Schluchter MD, Chak A, Cooper GS (2016) Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population. Gastrointest Endosc 84(2):232–240.e1. CrossRefGoogle Scholar
  24. 24.
    Bustamante FA, Hourneaux DE, Moura EG, Bernardo W, Sallum RA, Ide E, Baba E (2016) Surgery versus endoscopic therapies for early cancer and high-grade dysplasia in the esophagus: a systematic review. Arq Gastroenterol 53(1):10–19. CrossRefGoogle Scholar
  25. 25.
    Hollis AC, Quinn LM, Hodson J, Evans E, Plowright J, Begum R, Mitchell H, Hallissey MT, Whiting JL, Griffiths EA (2017) Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer. J Surg Oncol 116(8):1114–1122CrossRefGoogle Scholar
  26. 26.
    Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ (2014) Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst. Google Scholar
  27. 27.
    Pacifico RJ, Wang KK, Wongkeesong LM, Buttar NS, Lutzke LS (2003) Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol 1(4):252–257CrossRefGoogle Scholar
  28. 28.
    Reed MF, Tolis G Jr, Edil BH, Allan JS, Donahue DM, Gaissert HA, Moncure AC, Wain JC, Wright CD, Mathisen DJ (2005) Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 79(4):1110–1115CrossRefGoogle Scholar
  29. 29.
    Hulscher F, van Sandick J, de Boer A, Wijnhoven B, Tijssen J, Fockens P (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669CrossRefGoogle Scholar
  30. 30.
    Jamieson G, Mathew G, Ludemann R, Wayman J, Myers J, Devitt P (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 5(8):943–947CrossRefGoogle Scholar
  31. 31.
    Mohiuddin K, Dorer R, El Lakis MA, Hahn H, Speicher J, Hubka M, Low DE (2016) Outcomes of surgical resection of T1bN0 esophageal cancer and assessment of endoscopic mucosal resection for identifying low-risk cancers appropriate for endoscopic therapy. Ann Surg Oncol 23(8):2673–2678CrossRefGoogle Scholar
  32. 32.
    Wang S, Huang Y, Xie J, Zhuge L, Shao L, Xiang J, Zhang Y, Sun Y, Hu H, Chen S, Lerut T, Luketich JD, Zhang J, Chen H (2018) Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis. Surg Endosc 32(3):1441–1448CrossRefGoogle Scholar
  33. 33.
    Smith I, Kahaleh M (2015) Endoscopic versus surgical therapy for Barrett’s esophagus neoplasia. Expert Rev Gastroenterol Hepatol 9(1):31–35CrossRefGoogle Scholar
  34. 34.
    Kawaguchi G, Sasamoto R, Abe E, Ohta A, Sato H, Tanaka K, Maruyama K, Kaizu M, Ayukawa F, Yamana N, Liu J, Takeuchi M, Kobayashi M, Aoyama H (2015) The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol 10:31. CrossRefGoogle Scholar
  35. 35.
    Mariette C, Finzi L, Piessen G, Van Seuningen I, Triboulet JP (2005) Esophageal carcinoma: prognostic differences between squamous cell carcinoma and adenocarcinoma. World J Surg 29(1):39–45CrossRefGoogle Scholar
  36. 36.
    Arnold M, Soerjomataram I, Ferlay J, Forman D (2015) Global incidence of oesophageal cancer by histological subtype in 2012. Gut 64(3):381–387. CrossRefGoogle Scholar
  37. 37.
    Martínek J, Juhas S, Dolezel R, Walterová B, Juhasova J, Klima J, Rabekova Z, Vacková Z (2018) Prevention of esophageal strictures after circumferential endoscopic submucosal dissection. Minerva Chir 73(4):394–409. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Baisi Yuan
    • 1
  • Leilei Liu
    • 2
  • Hairong Huang
    • 3
  • Demin Li
    • 3
  • Yi Shen
    • 3
  • Bo Wu
    • 2
  • Jiong Liu
    • 1
  • Miaofang Yang
    • 1
  • Zhenkai Wang
    • 1
  • Heng Lu
    • 1
  • Yuxiu Liu
    • 4
  • Lianming Liao
    • 5
    Email author
  • Fangyu Wang
    • 1
    Email author
  1. 1.Department of Gastroenterology and HepatologyJinling HospitalNanjingChina
  2. 2.Department of PathologyJinling HospitalNanjingChina
  3. 3.Department of Cardiothoracic SurgeryJinling HospitalNanjingChina
  4. 4.Department of Medical AffairsJinling HospitalNanjingChina
  5. 5.Center of Laboratory Medicine, Union HospitalFujian Medical UniversityFuzhouChina

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