SURGERY VERSUS ENDOSCOPIC THERAPIES FOR EARLY CANCER AND HIGH-GRADE DYSPLASIA IN THE ESOPHAGUS: a systematic review.
BACKGROUND
Esophageal cancer occurs as a local disease in 22% of cases, and a minority of this disease is limited to the mucosa or submucosa (early lesions). Endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, laser therapy, and argon plasma coagulation have emerged as alternatives to surgical resection for early lesions.


OBJECTIVE
The aim of this systematic review is to identify studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in the endoscopic versus surgical therapies.


METHODS
A systematic review using MEDLINE, COCHRANE, EMBASE, EBSCO, LILACS, Library University of Sao Paulo, BVS, and SCOPE.


METHODS
Randomized controlled trial, controlled clinical trial, clinical trial, and cohort study.


METHODS
- Studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in patients who underwent endoscopic and surgical therapy for early lesions of esophageal cancer.


METHODS
Independent extraction of the articles by two authors using predefined data fields, including study quality indicators.


CONCLUSIONS
Only retrosprospective cohort studies comparing the endoscopic and surgical therapies were recovered.


RESULTS
The survival rates after 3 and 5 years were different and exhibited superiority with the surgical therapies over time. Endoscopy is superior in the control of mortality related to cancer with a high rate of disease recurrence. With regard to the comorbidity and the mortality associated with the procedure, endoscopy is superior.


CONCLUSIONS
There is no evidence from clinical trials. In this systematic review, surgical therapies showed superiority for survival, and endoscopic therapies showed superiority in the control of mortality related to cancer with a high rate of disease recurrence; also, for the comorbidity and the mortality associated with the procedure, endoscopy is superior. Prospective, controlled trials with large sample sizes are necessary to confirm the results of the current analysis.
Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP , Brazil.
Fabio Alberto Castillo
FA
Bustamante
Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP , Brazil.
Eduardo Guimarães
EG
Hourneaux DE Moura
Projeto Diretrizes, Associação Médica Brasileira, São Paulo, SP, Brasil, Associação Médica Brasileira, São Paulo SP , Brasil.
Wanderley
W
Bernardo
Divisão de Cirurgia Esofágica, Departamento de Gastroenterologia, Hospital das Clinicas Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Departamento de Gastroenterologia, Hospital das Clinicas, Universidade de São Paulo, São Paulo SP , Brazil.
Rubens Antonio Aissar
RA
Sallum
Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP , Brazil.
Edson
E
Ide
Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP , Brazil.
Elisa
E
Baba
D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis