P1.173. Endoscopic Resection Versus Esophagectomy for T1b Esophageal Cancer – a Systematic Review and Meta-Analysis

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Esophagectomy remains the standard of care for most esophageal cancer. Newer evidence supports the use of endoscopic resection (ER) including endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for T1a and T1b disease, respectively. We compared survival of patients with T1b esophageal cancer who underwent ER or esophagectomy. Methods We searched MEDLINE, EMBASE and CENTRAL from inception to April 2025 for studies comparing esophagectomy and ER for patients with T1b esophageal cancer. We excluded studies if patients received neoadjuvant treatment or ER before esophagectomy. Primary outcomes were 5-year cancer specific survival (CSS) and 5-year overall survival (OS). Secondary outcomes included postoperative complications. We used propensity-matched data when available and conducted a meta-analysis using a random effects model. A subgroup meta-analysis comparing ESD with esophagectomy was performed. Results Ten retrospective studies were identified comprising 2,491 patient who underwent ER (n=890) or esophagectomy (n=1,601). The mean age was 65.7 years. From the studies that reported sex, there were 16.1% females (223/1386). Six studies grouped EMR and ESD together, while three reported ESD data alone and one examined EMR only. CSS and OS data were available in four and seven studies respectively. In the studies that reported differentiation, the ER group has 400 well/moderate and 208 poorly differentiated patients, whilst the esophagectomy group had 410 and 217 patients, respectively. There was no significant difference between esophagectomy and ER group regarding 5-year CSS (HR 0.65; 95% CI 0.20-2.17; p = 0.49), 5-year OS (HR 1.26; 95% CI 1.00-1.60; p = 0.05), or 30-day mortality (HR 0.39; 95% CI 0.13-1.16; p = 0.09). Subgroup analysis demonstrated no difference in 5-yr OS or 30-day mortality. Conclusion 5-year CSS and OS is comparable between esophagectomy and ER for patients with T1b esophageal cancer. Randomized data are needed comparing EMR or ESD separately to esophagectomy.