Surgical Efficiency or Eradication Sufficiency

Abstract

The management of local and early mucosal cancer of the esophagus is an enormous challenge. There is a change in the practice developing with the establishment of endoscopic mucosal resection and other ablative techniques. Das et al. in this issue have used the Surveillance Epidemiology and End Results (SEER) database of the National Cancer Institute data to compare survival of 99 patients treated using endotherapy (endoscopic mucosal resection, thermal ablation, and photodynamic therapy), with 742 patients treated with surgical resection. Using the Cox proportional hazards model, there was no survival difference between the groups. The survival predictors were the age at diagnosis and the absence of radiotherapy. Although many patients are unsuitable for surgical excision and are offered alternative therapy, these data provide evidence that endotherapy may be an equally effective alternative for many patients with early esophageal cancer. It supports the need for randomized data where this can be achieved. These population-based data open up the possibility of wider acceptance of endoscopic techniques.