Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for esophagogastric junction adenocarcinoma

Abstract

Background Endoscopic submucosal dissection (ESD) has become accepted as the standard treatment for early gastric cancer. However, comparative outcomes of ESD and surgery have not been evaluated for adenocarcinoma in the esophagogastric junction (EGJ). We investigated the longterm outcomes of ESD compared with those of surgery for adenocarcinoma in the EGJ. Methods Patients who underwent ESD or surgery for Siewert type II adenocarcinoma between 2005 and 2010 and who met the absolute and expanded criteria for endoscopic resection were eligible. Clinical features and treatment outcomes were retrospectively reviewed using medical records. Results Of the 79 patients included, 40 underwent ESD and 39 underwent surgery. During the median follow-up period of 60.9 months (range, 13.1-125.4 months), the 5-year overall survival rates were 93.9% and 97.3% for the ESD and surgery groups, respectively (p = 0.376). There were no gastric cancer-related deaths in either group. Adverse events occurred in 11 patients (13.9%) overall, and the incidence of treatment-related adverse events was similar between the two groups (10.0% vs. 17.9%, p = 0.308).Conclusions ESD may be an effective alternative to surgery for the treatment of early gastric cancer in the EGJ based on the comparable long-term outcomes.

Overview of gastroesophageal junction cancers

“…The 5-year overall survival rates were similar in both groups. There was no gastric cancer related death in each group and the incidence of treatment-related adverse events was similar in both groups leading the authors to conclude that ESD may be an effective alternative to surgery with comparable long-term oncologic outcomes [27] . ESD has a good safety profile with low number of adverse events reported by many centers [28,29] .…”

AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer: Expert Review

“…Synchronous or metachronous lesions developed in 4 patients in ESD group. 26 (Figure 4 highlights post-ESD resection of T1 b lesions with central fibrosis and exposure of few muscularis propria fibers. )…”

Endoscopic Submucosal Dissection for Adenocarcinomas of the Esophagogastric Junction

“…Most cases were controlled with endoscopic hemostasis, clipping, or balloon dilation. In a comparative study with surgery, adverse events in the ESD group (10.0%) were similar to those in the surgery group (17.9%, p  = 0.308) [26]. In that study, 1 patient required emergency surgery due to uncontrolled bleeding in the ESD group, whereas 1 patient required surgery for ileus caused by internal herniation in the surgery group.…”

“…A larger study would be helpful in eliminating the long-term outcomes. One retrospective comparative study involving surgery demonstrated similar 5-year overall survival rates during the ESD and surgery during a long-term follow-up period (93.9 vs. 97.3%) [26]. No local recurrence and disease-specific death were observed.…”

“…Several causes have been considered. Gong et al [26] speculated that this outcome was dependent on the incomplete resection due to technical difficulties in performing ESD near the EGJ, such as narrow and curved space of the tubular esophagus flares. In addition, the difficulty in determining invasion depth also depends on this narrow space.…”