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Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population.


ABSTRACT: Endoscopic treatment of early esophageal cancer provides an alternative to esophagectomy, which older patients may not tolerate. Population-based data regarding short-term outcomes and recurrence after endoscopic treatment for esophageal cancer are limited. We compared short-term outcomes, treated recurrence, and survival after endoscopic versus surgical therapy for early esophageal cancers in an older population.We conducted a retrospective cohort study identifying patients aged ?66 years with Tis or T1a tumors without nodal involvement diagnosed from 1994 to 2011 from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database.Of 2193 patients, 41% (n = 893) underwent esophagectomy, and 12% (n = 255) underwent endoscopic treatment within 6 months of diagnosis. Those treated endoscopically were older and more likely to have a Charlson comorbidity score ?2. A composite endpoint, hospitalization and/or adverse events at 60 days, was higher in surgical patients than in the endoscopic treatment group (30% vs 12%; P < .001). In a Cox model stratified by histology, adjusting for other factors, endoscopic treatment was associated with improved 2-year survival (hazard ratio 0.51; 95% CI, 0.36-0.73).In this older population, a composite short-term endpoint was worse in the surgical group. Endoscopic treatment was associated with improved survival through 2 years. These results suggest that endoscopic treatment is a reasonable approach for early esophageal cancers in the elderly.

SUBMITTER: Cummings LC 

PROVIDER: S-EPMC4949078 | biostudies-other | 2016 Aug

REPOSITORIES: biostudies-other

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Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population.

Cummings Linda C LC   Kou Tzuyung Doug TD   Schluchter Mark D MD   Chak Amitabh A   Cooper Gregory S GS  

Gastrointestinal endoscopy 20160119 2


<h4>Background and aims</h4>Endoscopic treatment of early esophageal cancer provides an alternative to esophagectomy, which older patients may not tolerate. Population-based data regarding short-term outcomes and recurrence after endoscopic treatment for esophageal cancer are limited. We compared short-term outcomes, treated recurrence, and survival after endoscopic versus surgical therapy for early esophageal cancers in an older population.<h4>Methods</h4>We conducted a retrospective cohort stu  ...[more]

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