Endoscopic and Surgical Treatment of Mucosal (T1a) Esophageal Adenocarcinoma in Barrett's Esophagus

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 137; no. 3; pp. 815 - 823
• Main Authors: Prasad, Ganapathy A, Wu, Tsung Teh, Wigle, Dennis A, Buttar, Navtej S, Wongkeesong, Louis–Michel, Dunagan, Kelly T, Lutzke, Lori S, Borkenhagen, Lynn S, Wang, Kenneth K
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2009
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - etiology; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Aged; Barrett Esophagus - complications; Combined Modality Therapy; Disease-Free Survival; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - etiology; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy; Esophagoscopy; Female; Gastroenterology and Hepatology; Humans; Male; Mucous Membrane; Neoplasm Recurrence, Local; Photochemotherapy; Proton Pump Inhibitors - therapeutic use; PDT; BE; HGD; EAC; photodynamic therapy; endoscopically treated group; EMR; IQR; interquartile range; SURG; surgically treated group; esophageal adenocarcinoma; ENDO; Barrett's esophagus; endoscopic mucosal resection; high-grade dysplasia
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/j.gastro.2009.05.059

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.