Surgery versus endoscopic therapies for early cancer in the esophagus

Background: Esophageal cancer occurs in 22% of cases as a local disease, and a minority of this disease is limited to mucosa or submucosa (early lesions). Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), photodynamic therapy (PDT), laser therapy, and argon plasma coagulation (APC) have developed as alternatives to surgical resection for early lesions. Objectives: The aim of this systematic review is to identify studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated to cancer in the endoscopic and surgical therapy. Conclusions and implications: There is no evidence from clinical trials. These meta-analysis surgical therapies showed superiority in survival, and endoscopic therapies showed superiority in control of mortality related to cancer with a high rate of disease recurrence; also, comorbidity and mortality associated with endoscopy is superior. Prospective, controlled trials with large sample sizes are required to confirm the results of the current meta-analysis. Systematic review registration number: CRD42014013170