Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis
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Although endoscopic resection (ER) may be sufficient treatment for early-stage esophageal cancer, additional treatment is recommended when there is a high risk of cancer recurrence. It is unclear whether delaying esophagectomy by performing and assessing the success of ER affects outcomes as compared with immediate esophagectomy without ER. Additionally, long-term survival after sequential ER and esophagectomy required further investigation.
Between 2011 and 2015, 48 patients with stage T1 esophageal cancer underwent esophagectomy after ER with curative intent at our institution. Two-to-one propensity score methods were used to identify 96 matched-control patients who were treated with esophagectomy only using baseline patient, tumor characteristics and surgical approach. Time from initial evaluation to esophagectomy, relapse-free survival, overall survival, and postoperative complications were compared between the propensity-matched groups.
In the ER + esophagectomy group, the time from initial evaluation to esophagectomy was significantly longer than in the esophagectomy only group (114 vs. 8 days, p < 0.001). The incidence of dense adhesion (p = 0.347), operative time (p = 0.867), postoperative surgical complications (p = 0.966), and postoperative length of hospital stay (p = 0.125) were not significantly different between the groups. Moreover, recurrence-free survival and overall survival were also similar between the two groups (p = 0.411 and p = 0.817, respectively).
Treatment of stage T1 esophageal cancer with ER prior to esophagectomy did not increase the difficulty of performing esophagectomy or the incidence of postoperative complications and did not affect survival after esophagectomy. These results suggest that ER can be recommended for patients with stage T1 cancer even if esophagectomy is warranted eventually.
KeywordsEndoscopic mucosal resection Endoscopic submucosal resection Esophagectomy Esophageal neoplasms Propensity score
This work is supported, in part, by Shanghai Science and Technology Commission Foundation key project (14JC140140), Grant from Science and Technology Commission of Shanghai Municipality (No. 15411951602; No. 16401970704), Trans-Century Training Programme Foundation for the Talents by the State Education Commission (NCET-13-0148), Grant from Health and Family Planning Commission of Shanghai Municipality (No. XYQ2011025; No. 2013ZYJB0301). We thank Shannon Wyszomierski, Ph.D. for editing the manuscript.
Compliance with ethical standards
Shengfei Wang, Yangle Huang, Juntao Xie, Lingdun Zhuge, Longlong Shao, Jiaqing Xiang, Yawei Zhang, Yihua Sun, Hong Hu, Sufeng Chen, Toni Lerut, James Luketich, Jie Zhang, and Haiquan Chen have no conflicts of interest or financial ties to disclose.
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