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

Received 6 February 2009; accepted 29 May 2009. published online 15 June 2009.

Refers to article:

Continuing Medical Education Exam 1, September 2009 , 03 August 2009
Michael B. Wallace
Gastroenterology
September 2009 (Vol. 137, Issue 3, Pages 1161-1162)
Full-Text PDF (86 KB)

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.

Abbreviations used in this paper: BE, Barrett's esophagus, EAC, esophageal adenocarcinoma, EMR, endoscopic mucosal resection, ENDO, endoscopically treated group, HGD, high-grade dysplasia, IQR, interquartile range, PDT, photodynamic therapy, SURG, surgically treated group

⁎ Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota

‡ Department of Laboratory Medicine and Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota

§ Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

Reprint requests Kenneth K. Wang, MD, Alfred Main, St. Mary's Hospital, 200, First Street SW, Rochester, Minnesota. fax: (507) 255-7612

Conflicts of interest The authors disclose no conflicts.

Funding Supported by National Institutes of Health grants R01CA111603-01A1 (K.K.W.), R01CA097048 (K.K.W.), R21CA122426-01 (K.K.W.), and R03CA135991-01 (G.A.P.), and the Shirley and Miles Fiterman Digestive Disease Center.

PII: S0016-5085(09)00914-7

doi:10.1053/j.gastro.2009.05.059

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