title: Outcomes after endoscopic versus surgical therapy for early esophageal cancers in an older population.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Cummings
authors.affiliation: Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Tzuyung Doug
authors.initials: TD
authors.lastname: Kou
authors.affiliation: Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schluchter
authors.affiliation: Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.affiliation: Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, USA; Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States