Impact of primary endoscopic resection on oncological outcomes after esophagectomy for cancer: a retrospective propensity score-based cohort study.

Autor: Teixeira-Farinha H; Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France.; Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland., Béhal H; Biostatistics Department, CHU Lille, 59000, Lille, France., Cailliau E; Biostatistics Department, CHU Lille, 59000, Lille, France., Pasquer A; Digestive Surgery Department, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France., Duhamel A; Biostatistics Department, CHU Lille, 59000, Lille, France., Théréaux J; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France., Chalret du Rieu M; Service de Chirurgie Bariatrique, Ramsay Générale de Santé, Clinique Des Cedres, Cornebarrieu, France., Lefevre JH; Department of Digestive and General Surgery, Hôpital Saint-Antoine, Sorbonne Université, Paris, France., Turner K; Department of Gastrointestinal and Hepatic Surgery, Rennes University Hospital Center, Rennes, France., Mantziari S; Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland., Collet D; Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France.; Faculty of Medicine, Bordeaux Ségalen University, Bordeaux, France., Piessen G; Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, Lille, France.; CNRS, Inserm, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, CHU Lille, Univ. Lille, 59000, Lille, France., Gronnier C; Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France. caroline.gronnier@chu-bordeaux.fr.; Faculty of Medicine, Bordeaux Ségalen University, Bordeaux, France. caroline.gronnier@chu-bordeaux.fr.; Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600, Pessac, France. caroline.gronnier@chu-bordeaux.fr.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Sep; Vol. 38 (9), pp. 5169-5177. Date of Electronic Publication: 2024 Jul 22.
DOI: 10.1007/s00464-024-11077-2
Abstrakt: Background: Esophageal cancer posed significant global health challenges, particularly due to poor survival rates, especially in advanced stages. Primary endoscopic resection had emerged as an alternative treatment for early esophageal cancer, aiming to preserve organ function and reduce surgical morbidity.
Methods: This retrospective multicenter cohort study included 334 patients with early esophageal cancer (T1a-b, N0) from 30 French-speaking European centers between 2000 and 2010. Patients underwent either primary endoscopic resection followed by esophagectomy (E group, n = 36) or esophagectomy alone (S group, n = 298). Cox proportional hazards models adjusted for TNM stage and propensity score weighting were used to assess the impact of primary endoscopic resection on recurrence-free survival (RFS), overall survival (OS), and postoperative complications.
Results: Primary endoscopic resection did not significantly influence RFS (adjusted HR 0.92, 95% CI 0.31 to 2.68, p = 0.88) or OS (adjusted HR 1.06, 95% CI 0.35 to 3.13, p = 0.92) compared to esophagectomy alone. Initial higher thromboembolic complications in the endoscopic resection group were not significant after adjustment (adjusted OR 4.73, 95% CI 0.34 to 64.27, p = 0.24).
Conclusions: Primary endoscopic resection followed by esophagectomy for early esophageal cancer did not alter oncological outcomes or overall survival in this retrospective cohort. These findings supported the role of primary endoscopic resection as a safe initial treatment strategy, warranting validation in larger prospective studies.
Registration: Our study was registered retrospectively on the Clinicaltrials.com website under the identifier NCT01927016. We acknowledge the importance of prospective registration and regret that this was not done before the commencement of the study.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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