Surgery versus endoscopic therapies for early oesophageal cancer in Barrett's oesophagus

Bennett C, Green S, Barr H, Bhandari P, DeCaestecker J, Ragunath K, Singh R, Tawil A, Jankowski J

Published Online:

November 10, 2010

This Cochrane review has indicated that there are no randomised controlled trials to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. Current use of endotherapies in the care of patients with early cancer or high grade dysplasia of Barrett's oesophagus should be at the recommendation of the multi-disciplinary team involved in individual care. Properly conducted randomised controlled trials comparing surgery with endotherapies should be conducted before any conclusions can be drawn.

Abstract (click to read)

Background:

Barrett's oesophagus is one of the most common premalignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little in the last 30 years. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes. Success of this strategy relies on the fact that late stage premalignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: i.e. conventional open surgery or endotherapy (techniques involving endoscopy).

Objectives:

We used data from randomised controlled trials to examine the effectiveness of endotherapies compared with surgery, in people with Barrett's Oesophagus; those with early neoplasias (defined as high grade dysplasia (HGD), and those with early cancer (defined as carcinoma in-situ, superficially invasive, early cancer or superficial cancer T-1m (T1-a) and T-1sm (T1-b)).

Search strategy:

We used the Cochrane highly sensitive search strategy to identify randomised trials in MEDLINE, EMBASE, CENTRAL, ISI Web of Science, EBMR, Controlled Trials mRCT and ISRCTN and LILACS, in July and August 2008.

Selection criteria:

Types of studies: randomised controlled trials comparing endotherapies with surgery in the treatment of high grade dysplasia (HGD), or early cancer. All cellular types of cancer were included (i.e. adenocarcinomas, squamous cell carcinomas and more unusual types) but will be discussed separately.

Types of participants: patients of any age and either gender with a histologically confirmed diagnosis of early neoplasia (HGD and early cancer) in Barrett's or squamous lined oesophagus.

Types of interventions; endotherapies (the intervention) compared with surgery (the control), all with curative intent.

Data collection and analysis:

Reports of studies which meet the inclusion criteria for this review would have been analysed using the methods detailed in Appendix 9.

Main results:

We did not identify any studies which met the inclusion criteria.

Authors' conclusions:

This Cochrane review has indicated that there are no randomised control trials to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites; standardising histopathology in all centres; assessing which patients are fit or unfit for surgery; and making sure there are relevant outcomes for the study i.e. long term survival (over five or more years) and no progression of high grade dysplasia.

This record should be cited as:

Bennett C, Green S, Barr H, Bhandari P, DeCaestecker J, Ragunath K, Singh R, Tawil A, Jankowski J. Surgery versus radical endotherapies for early cancer and high grade dysplasia in Barrett's oesophagus. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD007334. DOI: 10.1002/14651858.CD007334.pub3

Assessed as up to date:

January 18, 2010

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Primary Review Group:

Upper Gastrointestinal and Pancreatic Diseases Group

Health topics:

Gastroenterology > Cancer: oesophagus > Treatment

Cancer > Oesophagus

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgery versus endoscopic therapies for early oesophageal cancer in Barrett's oesophagus

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