Sa1298 ENDOSCOPIC SUBMUCOSAL DISSECTION VERSUS ESOPHAGECTOMY FOR THE TREATMENT OF SUPERFICIAL ESOPHAGEAL LESIONS: A RETROSPECTIVE COMPARATIVE ANALYSIS

Abstract

Dysplastic lesions associated with Barrett’s esophagus are commonly treated with endoscopic mucosal resection (EMR). Lesions refractory to EMR or with positive margins for intramucosal adenocarcinoma are commonly referred for esophagectomy. While typically curative, esophagectomy is associated with significant complications and morbidity. More recently, endoscopic submucosal dissection (ESD) has emerged as a recognized modality for dysplastic Barretts esophagus and non invasive adenocarcinoma, with high curative resection rates and low risks of complications. The aim of this study is to evaluate the comparative effectiveness of ESD versus esophagectomy for dysplastic Barrett’s esophageal lesions and non-invasive adenocarcinoma. This was a single-center retrospective study of adult patients that underwent ESD and surgical esophagectomy for the treatment of superficial esophageal lesions. Using the TNM staging classification, only T1aM0N0 lesions were included to ensure lesions were amenable to both treatment strategies. Baseline data was collected for age, gender, size of lesion, prior EMR, procedure times, and pathology. Cases with invasive cancers were excluded from the final analysis. Primary outcomes were procedure-associated adverse events and evidence of local recurrence. Secondary outcomes included adverse events and recurrence rates. Statistical analyses were performed using Student’s t-test or Fisher’s exact test with statistical significance defined as P<0.05. A total of 17 patients underwent ESD with 34 patients undergoing surgical esophagectomy at our institution. Baseline patient, lesion, and procedure characteristics are summarized in Table 1. Mean age, gender, and histologic pathology was not difference between ESD and esophagectomy. For ESD, en-bloc resection was achieved in 100% of patients with 4 (23.53%) patients having undergone previous resection attempts or treatment with radiofrequency ablation. A majority of patients in the esophagectomy group (71.88%) underwent minimally invasive Ivor Lewis procedures, with the other patients undergoing transhiatal (18.75%) or three-hole (9.38%) surgeries. Esophagectomy resulted in significantly longer hospitalization [8.58 ±6.25 vs 0.00 ±0.00; P<0.001] with more procedure-associated adverse events [61.76% vs 11.76%; P<0.001]. Post-procedure esophageal stricture formation was also higher for the esophagectomy group [41.18% vs 11.76%; P<0.050]. Both ESD and esophagectomy were curative with no cases of local recurrence in either group. In this retrospective study of dysplastic Barrett’s and T1aM0N0 esophageal lesions, ESD was associated with comparable curative resection rates to esophagectomy however with shorter length of hospital stay, fewer procedure related adverse events and less stricture formation.