Endoscopic treatment provides long-term remission or cure in a considerable number of patients with high-risk oesophageal adenocarcinoma (OAC) and may represent a valid alternative to surgery, according to the findings of a new study presented at the 2019 ESMO World Congress on Gastrointestinal Cancer.
In the study, patients with high-risk early oesophageal cancer (EOC) underwent endoscopic resection (ER) or submucosal dissection (ESD). Patients with high-risk EOC without contraindications were referred for surgery (n=24) and 47 continued endoscopic treatment.
In the endoscopy group, complete local remission (CLR) was achieved in 45/47 patients (95.7%). Two patients without CLR continued endoscopic therapy with palliative intent. Tumour generalisation occurred in two patients. Tumour-free survival was 84 months.
One patient in the oesophagectomy group had generalisation revealed during surgery. Local residual malignancy was present in six of the remaining 23 patients.
A total of 484 lymph nodes (LNs) were evaluated. LN metastases were detected in one patient and micrometastases were detected in another two patients. Surgery-related mortality was 4.4 per cent.
The study authors highlight the “surprisingly low” risk of LN metastases and micrometastases and say endoscopic treatment may represent a valid alternative to surgery in this patient population.