COMPARATIVE STUDY OF SURGICAL AND ENDOSCOPIC TREATMENT FOR EARLY GASTROESOPHAGEAL JUNCTION CANCERS

Aims Gastroesophageal junction (GEJ) cancers have increased in incidence. Early GEJ cancers may be submitted both to endoscopic or surgical treatment, depending on staging and patients’ preferences and risks. However, there are no studies comparing endoscopic and surgical treatment of early GEJ cancers. We aimed to compare the efficacy and safety of endoscopic and surgical treatment.

Methods A retrospective assessment of all consecutive patients presenting with early GEJ cancers in a tertiary center from January 2011 to December 2018 was conducted. Data included curative resection, adverse events (AEs), metachronous lesions and mortality.

Results Forty-six patients with early lesions were included - 34 managed endoscopically and 12 by surgery. The former group had significantly more patients on antithrombotic medication and included lesions in any GEJ location besides cardia . Complete resection was similar in the surgical and endoscopic group (92% vs 88%; p= 1.0). Complete resection was lower in T1b lesions (LGD/HGD 100% vs T1a 91% vs T1b 67%; p=0.42) with no differences between surgical and endoscopic group. AEs were more frequent in surgical than endoscopic group (50% vs 30%; p=0.06) and significantly more severe (25% vs 8.8% for grade III and 8.3% vs 0% for grade IV of Clavien-Dindo classification; p=0.005) even in subgroup analysis by ASA and histology though not statistically significant. The endoscopic group had significantly higher risk of metachronous lesions (21.9% vs 0%;p=0.000 01). Re-intervention, disease progression and cancer-related death did not differ between the groups.

Conclusions Although the small sample and the retrospective design, this is the first study demonstrating that endoscopic treatment is equally curative and safer than surgery.