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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Nov 28, 2019; 7(9): 406-417
Published online Nov 28, 2019. doi: 10.13105/wjma.v7.i9.406
Treatment of early stage (T1) esophageal adenocarcinoma: Personalizing the best therapy choice
Lindsay Danielle Kumble, Elisabeth Silver, Aaron Oh, Julian A Abrams, Joshua R Sonett, Chin Hur
Lindsay Danielle Kumble, Elisabeth Silver, Aaron Oh, General Medicine, Columbia University Medical Center, New York, NY 10032, United States
Julian A Abrams, Joshua R Sonett, Chin Hur, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States
Author contributions: Oh A, Silver E, and Kumble LD performed research; Abrams JA, Sonett JR, Hur C edited and provided feedback for the manuscript; Kumble LD, Silver E wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chin Hur, MD, Doctor, Department of Medicine, Columbia University Irving Medical Center, 622 W. 168th Street, Presbyterian Hospital 9-105, New York, NY 10032, United States. ch447@cumc.columbia.edu
Telephone: +1-646-3173533 Fax: +1-212-3051081
Received: August 9, 2019
Peer-review started: August 9, 2019
First decision: September 19, 2019
Revised: October 3, 2019
Accepted: October 20, 2019
Article in press: October 20, 2019
Published online: November 28, 2019
Abstract

Esophagectomy is considered the primary form of management for esophageal adenocarcinoma (EAC); however, the surgery is associated with high rates of morbidity and mortality. For patients with early-stage EAC, endoscopic resection (ER) presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks, but it is associated with higher rates of cancer recurrence following the procedure. For some patients, age and comorbidities may prevent them from having esophagectomy as a treatment option, while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences. Furthermore, while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life (QOL), so might the morbidity surrounding esophagectomy. In addition to considering health status, patient preferences, and impacts on QOL, physicians and patients must also consider what treatments would be both beneficial and available to the patient, considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER. Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data. We conclude with a request for more research of available options for early EAC patients, the conditions that determine when each option should be employed, and their effects not only on patient health but also QOL.

Keywords: Esophageal cancer, Adenocarcinoma, T1b, Esophagectomy, Endoscopic resection, Chemoradiotherapy, Quality of life

Core tip: This paper is an important source of information for patients and clinicians faced with a diagnosis of T1b esophageal adenocarcinoma (T1b EAC). This paper explores and then outlines the potential benefits and risks of the numerous treatment options for T1b EAC, highlighting the integral role a patient’s individual wishes and values play into making a treatment decision that achieves the greatest outcome for that patient. The review advocates for further research regarding the effects of T1b EAC treatment options on a patient’s quality of life.