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Comparative Study
. 2016 Aug;84(2):232-240.e1.
doi: 10.1016/j.gie.2016.01.019. Epub 2016 Jan 19.

Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population

Linda C Cummings  1 , Tzuyung Doug Kou  2 , Mark D Schluchter  2 , Amitabh Chak  1 , Gregory S Cooper  1
Affiliations
Comparative Study

Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population

Linda C Cummings et al. Gastrointest Endosc. 2016 Aug.

Abstract

Background and aims: Endoscopic treatment of early esophageal cancer provides an alternative to esophagectomy, which older patients may not tolerate. Population-based data regarding short-term outcomes and recurrence after endoscopic treatment for esophageal cancer are limited. We compared short-term outcomes, treated recurrence, and survival after endoscopic versus surgical therapy for early esophageal cancers in an older population.

Methods: We conducted a retrospective cohort study identifying patients aged ≥66 years with Tis or T1a tumors without nodal involvement diagnosed from 1994 to 2011 from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database.

Results: Of 2193 patients, 41% (n = 893) underwent esophagectomy, and 12% (n = 255) underwent endoscopic treatment within 6 months of diagnosis. Those treated endoscopically were older and more likely to have a Charlson comorbidity score ≥2. A composite endpoint, hospitalization and/or adverse events at 60 days, was higher in surgical patients than in the endoscopic treatment group (30% vs 12%; P < .001). In a Cox model stratified by histology, adjusting for other factors, endoscopic treatment was associated with improved 2-year survival (hazard ratio 0.51; 95% CI, 0.36-0.73).

Conclusions: In this older population, a composite short-term endpoint was worse in the surgical group. Endoscopic treatment was associated with improved survival through 2 years. These results suggest that endoscopic treatment is a reasonable approach for early esophageal cancers in the elderly.

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Figures

Figure 1
Figure 1
Stepwise patient selection flowsheet. Percentage in parentheses indicates the proportion of patients excluded at each step. HMO, Health Maintenance Organization; AHRF; Area Health Resources Files
Figure 2
Figure 2
Kaplan-Meier overall survival curves for patients undergoing endoscopic treatment versus surgical resection for early esophageal cancer. ET, Endoscopic Treatment.
See this image and copyright information in PMC

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