Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4698
Peer-review started: August 1, 2018
First decision: August 24, 2018
Revised: September 29, 2018
Accepted: October 16, 2018
Article in press: October 16, 2018
Published online: November 7, 2018
This study provides long-term outcome data on patients with submucosal oesophageal adenocarcinoma.
The optimal management of submucosal oesophageal adenocarcinoma is not clearly defined. Data suggests endoscopic therapy may be a viable alternative to surgery and thus radically change the treatment paradigm.
To analyse our data from a large tertiary specialist centre on the management of patients with submucosal oesophageal adenocarcinoma in order to support the potential for endoscopic therapy for these patients. In addition, we feel our work promotes the need for a large-scale multi-centre trial exploring endoscopic therapy for submucosal lesions.
This was a retrospective cohort study that uniquely offers long-term outcomes on patients with high-risk and low-risk oesophageal submucosal lesions who received surgery and endoscopic therapy.
Lymph node metastases were detected in 18% of patients who had undergone conservative management. There was no statistically significant difference in tumour-related deaths between those treated surgically or conservatively and disease-specific survival time was also comparable between the two treatment strategies.
This study provides supporting data for the potential of endoscopic therapy in the management of submucosal oesophageal adenocarcinoma. In particular, the work suggests that endoscopic therapy may be a viable alternative to surgery in selected patients. This work could support a change to the treatment strategy for submucosal lesions.
Low-risk submucosal lesions can be safely treated endoscopically whilst our research suggests that endoscopic therapy may be a viable option for high-risk lesions. This study supports the need for a large-scale multicentre study addressing this uncertainty in the treatment paradigm.