title: Surgery versus radical endotherapies for early cancer and high-grade dysplasia in Barrett's oesophagus.
abstract: BACKGROUND
  Barrett's oesophagus is one of the most common pre-malignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little since the 1980s. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes. Success of this strategy relies on the fact that late-stage pre-malignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: that is conventional open surgery or endotherapy (techniques involving endoscopy).
  
  
  OBJECTIVE
  We used data from randomised controlled trials (RCTs) to examine the effectiveness of endotherapies compared with surgery in people with Barrett's oesophagus, those with early neoplasias (defined as high-grade dysplasia (HGD) and those with early cancer (defined as carcinoma in-situ, superficially invasive, early cancer or superficial cancer T-1m (T1-a) and T-1sm (T1-b)).
  
  
  METHODS
  We used the Cochrane highly sensitive search strategy to identify RCTs in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, EBMR, Controlled Trials mRCT and ISRCTN, and LILACS, in July and August 2008. The searches were updated in 2009 and again in April 2012.
  
  
  METHODS
  Types of studies: RCTs comparing endotherapies with surgery in the treatment of or early cancer. All cellular types of cancer were included (i.e. adenocarcinomas, squamous cell carcinomas and more unusual types) but will be discussed separately.
  
  
  METHODS
  patients of any age and either gender with a histologically confirmed diagnosis of early neoplasia (HGD and early cancer) in Barrett's or squamous lined oesophagus.Types of interventions; endotherapies (the intervention) compared with surgery (the control), all with curative intent.
  
  
  METHODS
  Reports of studies that meet the inclusion criteria for this review would have been analysed using the methods detailed in Appendix 9.
  
  
  RESULTS
  We did not identify any studies that met the inclusion criteria. In total we excluded 13 studies that were not RCTs but that compared surgery and endotherapies.
  
  
  CONCLUSIONS
  This Cochrane review has indicated that there are no RCTs to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites, standardising histopathology in all centres, assessing which patients are fit or unfit for surgery and making sure there are relevant outcomes for the study (i.e. long-term survival (over five or more years)) and no progression of HGD.
authors.affiliation: Centre for Digestive Diseases, Blizard Institute, Queen Mary, University of London, London, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Bennett
authors.forename: Susi
authors.initials: S
authors.lastname: Green
authors.forename: John
authors.initials: J
authors.lastname: Decaestecker
authors.forename: Max
authors.initials: M
authors.lastname: Almond
authors.forename: Hugh
authors.initials: H
authors.lastname: Barr
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.forename: Rajvinder
authors.initials: R
authors.lastname: Singh
authors.forename: Janusz
authors.initials: J
authors.lastname: Jankowski
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*