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13-09-2009 | Gastroenterology | Article

Endoscopic treatment ‘reasonable’ for mucosal esophageal adenocarcinoma

Abstract

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MedWire News: Endoscopic and surgical treatment for mucosal (T1a) esophageal adenocarcinoma (EAC) appear to result in similar overall survival and comparable low recurrence rates, research suggests.

Recurrent carcinoma was endoscopically treatable in most patients receiving endoscopic mucosal resection (EMR) with the option of photodynamic therapy, and it did not influence overall survival.

The researchers say: “Endoscopic therapy with EMR and/or ablative therapy appears to be a reasonable alternative to esophagectomy.”

Esophagectomy is the standard of care for EAC patients but it is associated with mortality of up to 10% as well as substantial morbidity, explain Kenneth Wang (Mayo Clinic, Rochester, Minnesota, USA) and colleagues.

They add that endoscopic therapy is emerging as an alternative to surgery in mucosal (T1a) EAC, given the low likelihood of lymph node metastases.

In this study, the team compared the long-term outcomes of patients with mucosal EAC treated endoscopically or surgically between 1998 and 2007 at their institution.

Of the 178 patients studied, 132 (74%) were endoscopically treated, with photodynamic therapy sometimes administered after histological remission, while 46 (26%) were surgically treated.

Mean follow-up was 64 months in surgical patients and 43 months in endoscopic patients.

Cumulative mortality did not significantly differ, at 17% in endoscopically treated patients and 20% in surgically treated ones. Overall survival was also comparable in Kaplan–Meier analysis, and treatment modality did not significant predict survival in multivariable analysis.

Recurrent carcinoma was detected in 12% of endoscopic patients, the authors acknowledge in the journal Gastroenterology.

“This recurrence rate did give esophagectomy an advantage as far as cancer-free survival was concerned but it is important to note that all of these recurrent cancers including the one managed with esophagectomy could be managed endoscopically,” they add.

“Given these results, endoscopic management appears to be a viable alternative to esophagectomy for patients with mucosal (T1a) esophageal adenocarcinoma.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Anita Wilkinson