Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population.
Gastrointest Endosc
; 84(2): 232-240.e1, 2016 Aug.
Article
en En
| MEDLINE
| ID: mdl-26801375
ABSTRACT
BACKGROUND AND AIMS:
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.METHODS:
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.RESULTS:
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).CONCLUSIONS:
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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Neoplasias Esofágicas
/
Carcinoma de Células Escamosas
/
Adenocarcinoma
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Esofagoscopía
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Esofagectomía
/
Resección Endoscópica de la Mucosa
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Aged80
/
Female
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Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Gastrointest Endosc
Año:
2016
Tipo del documento:
Article
País de afiliación:
Estados Unidos