For early-stage esophageal cancer, traditional surgical resection has better outcomes than endoscopic resection, according to a recent study published in the Journal of the National Cancer Institute. This is the largest study to date comparing the two procedures for the treatment of the condition.

"We felt this was an important area to expand on existing studies from single centers to do a multicenter evaluation," Dr. David J. Bentrem, senior author of the study and director of the gastrointestinal oncology lab at Northwestern Memorial Hospital, wrote to DOTmed News.

The researchers at Northwestern Medicine used the National Cancer Data Base — an American College of Surgeons Commission on Cancer and American Cancer Society program — and reviewed the outcomes of over 5,000 patients from 824 different hospitals.

They found that even though surgical resection is a more invasive procedure, it was associated with an 87.6 percent five-year survival rate compared to a 76 percent five-year survival rate for endoscopic resection.

In addition to the survival rates, the researchers also investigated the increasing use of endoscopic esophageal resection. They found that its usage increased from 19 percent in 2004 to 53 percent in 2010 for T1a cancers — the cancer is growing into the lamina propria or muscularis mucosa — and increased from 6.6 percent in 2004 to 20.9 percent in 2010 for T1b cancers — the cancer has grown through the other layers and into the submucosa.

Even though there isn't strong evidence-based research that supports that it's the best treatment option, more and more physicians are opting to perform the procedure. The reason is because there are small single center studies that suggest that the procedure is a safe technique when experts perform it.

"Due to the complexity and morbidity of esophageal surgery, there was relatively quick adoption of these endoscopic techniques," Dr. Rajesh N. Keswani, co-author of the study and interventional gastroenterologist at Northwestern Medicine, wrote to DOTmed News.

Early mucosal lesions that don't have any aggressive features on pathology have a very low risk of nodal metastasis so endoscopic resection is the best treatment because it leads to fewer procedural risks, wrote Keswani. However, patients with mucosal tumors that do have aggressive features or tumors that have gone into the deeper submucosal layer have a much higher risk of lymph node disease, so surgical resection would be the better option.

The researchers hope that clinicians will have discussions with expert endoscopists, surgeons, pathologists and oncologists about whether endoscopic resection is the best treatment option before performing it on a patient. "The best treatment isn't simply the one that you can perform, it's the option that is going to provide the most durable response with the least risk," wrote Keswani.

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