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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
Article
  • 64 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

Compliance with ethical standards

Disclosures

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.

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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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