P115 TRANSITION FROM OESOPHAGECTOMY TO ENDOSCOPIC THERAPY FOR EARLY OESOPHAGEAL CANCER – A SINGLE CENTRE EXPERIENCE OF 251 CONSECUTIVE CASES. (23rd November 2019)

• Record Type: Journal Article
• Authors: Reyhani, A; J.M, Dunn; Zylstra, J; Santaolalla, A; Gimson, E; Baker, C; Kelly, M; Van Hemelrijck, M; Zeki, S S; Gossage, J; Davies, A
• Is Part Of: Diseases of the esophagus. Volume 32(2019)Supplement 2
• Publication Date: 2019-11-23
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doz092.115
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Aim: To compare Oesophagectomy and Endoscopic mucosal resection (EMR) short and long term outcomes of patients treated for early oesophageal cancer over a transition period in a single institution. Background and Methods: Introduction of Endoscopic eradication therapy (EET) techniques in 2012 provided an alternative to oesophagectomy for high grade dysplasia (HGD) and early cancer. Historically the gold-standard treatment had been oesophagectomy, which is associated with significant post-operative morbidity and prolonged recovery, but offers a high chance of cure with additional benefit of regional lymphadenectomy. A single centre, contemporaneously maintained database of consecutive patients diagnosed with early oesophageal cancer and treated at a tertiary referral centre during 2000-2018 was analysed. Patients were discussed at MDT; histology was confirmed by 2 expert pathologists. Oesophagectomy was not preceded by neoadjuvant chemotherapy. Primary outcomes are overall and disease specific survival, secondary outcomes including hospital stay, complications and overall cost. Results: 113 patients underwent oesophagectomy and 138 underwent EMR +/- further EET. Mean age for oesophagectomy 64.6 vs. EMR 71.6 years (p=<.0001). Mean follow up for oesophagectomy was 5.6 vs 2.4 years after EET. The proportion of T1 tumours was (HGD 25% vs 39%, T1a 17% vs 34%, T1b 43% vs 16%, p<0.001), poor differentiation (23% vs 5%, p<0.001), lymphovascular invasion (19% vs 4%, p<0.001) and Inpatient hospital stay (median 14 vs 1.5 days EMR; p=<.0001) was significantly higher in oesophagectomy group. In-hospital and 30 day mortality was 0%. Surgical group suffered more complications (Clavien-dindo ≥ 3) 26% vs. EMR 1%, p=<.0001. Cancer recurrence after oesophagectomy was 18% (local 4%, systemic 9%, mixed 5%) vs. 5% following EET (local). Overall survival showed no difference between both groups (HR 1.157 95%CI 0.62-2.16). Stage matched survival in HGD; T1a and T1b sub-groups didn´t significantly differ. Conclusion: In a large consecutive series of patients treated during a transition period, overall survival was similar in both groups. Surgery was associated with prolonged recovery and significant post-operative morbidity. EMR should be available for HGD and early cancer patients as gold standard of care although patients with adverse prognostic features may still benefit from oesophagectomy.