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. 2020 May 22;5(5):CD007334.
doi: 10.1002/14651858.CD007334.pub5.

Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett's oesophagus

Cathy Bennett  1 , Susi Green  2 , John DeCaestecker  3 , Max Almond  4 , Hugh Barr  5 , Pradeep Bhandari  6 , Krish Ragunath  7 , Rajvinder Singh  8 , Janusz Jankowski  9
Affiliations

Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett's oesophagus

Cathy Bennett et al. Cochrane Database Syst Rev. .

Abstract

Background: Barrett's oesophagus is one of the most common pre-malignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little since the 1980s. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes. Success of this strategy relies on the fact that late-stage pre-malignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: that is conventional open surgery or endotherapy (techniques involving endoscopy).

Objectives: We used data from randomised controlled trials (RCTs) to examine the effectiveness of endotherapies compared with surgery in people with Barrett's oesophagus, those with early neoplasias (defined as high-grade dysplasia (HGD) and those with early cancer (defined as carcinoma in-situ, superficially invasive, early cancer or superficial cancer T-1m (T1-a) and T-1sm (T1-b)).

Search methods: We used the Cochrane highly sensitive search strategy to identify RCTs in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, EBMR, Controlled Trials mRCT and ISRCTN, and LILACS, in July and August 2008. The searches were updated in 2009 and again in April 2012.

Selection criteria: Types of studies: RCTs comparing endotherapies with surgery in the treatment of high-grade dysplasia or early cancer. All cellular types of cancer were included (i.e. adenocarcinomas, squamous cell carcinomas and more unusual types) but will be discussed separately.

Types of participants: patients of any age and either gender with a histologically confirmed diagnosis of early neoplasia (HGD and early cancer) in Barrett's or squamous lined oesophagus. Types of interventions; endotherapies (the intervention) compared with surgery (the control), all with curative intent.

Data collection and analysis: Reports of studies that meet the inclusion criteria for this review would have been analysed using the methods detailed in Appendix 9.

Main results: We did not identify any studies that met the inclusion criteria. In total we excluded 13 studies that were not RCTs but that compared surgery and endotherapies.

Authors' conclusions: This Cochrane review has indicated that there are no RCTs to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites, standardising histopathology in all centres, assessing which patients are fit or unfit for surgery and making sure there are relevant outcomes for the study (i.e. long-term survival (over five or more years)) and no progression of HGD.

PubMed Disclaimer

Conflict of interest statement

JJ is a consultant to AstraZeneca.

CB is an independent researcher and the proprietor of Systematic Research Ltd, a company that provides research support in evidence‐based medicine.

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

Das 2008 {published data only}
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Pacifico 2003 {published data only}
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Pech 2011 {published data only}
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Prasad 2007 {published data only}
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Rosmolen 2010 {published data only}
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Schembre 2008 {published data only}
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Schembre 2010 {published data only}
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References to other published versions of this review

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