Dr. F. A. C. Bustamante

Dr. F. A. C. Bustamante |Clyto Access

University of Sao Paulo, Brazil

Speaker

Expertise: Gastrointestinal Endoscopy, Esophagus Cancer

Biography: Fabio Alberto Castillo Bustamante carried out his general surgery specialist degree in Forest University Bogota Colombia and he carried specialist in gastrointestinal endoscopy degree in Hospital Das Clinics Faculty of Medicine University of Sao Paulo .Later, he started working as an Assistant professor in University of Sao Paulo, Brazil.

Presentation:

Title: surgery versus endoscopic therapies for early cancer and high-grade dysplasia in the esophagus: a systematic review and meta-analysis

Abstract:

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 early lesions of esophageal cancer in the endoscopic and surgical therapy. 

Data sources: A systematic review of English and non-English articles using MEDLINE and the Cochrane Controlled Trials Register, EMBASE, EBSCO, LILACS, Library University of Sao Paulo, Research website BVS and SCOPE Science Direct.

Study Selection: Randomized Controlled Trial, Controlled Clinical Trial, Clinical Trial, and Cohort Study.

Criteria: 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 for early lesions of esophageal cancer.

Data Extraction: Independent extraction of articles by two authors using predefined data fields, including study quality indicators. In the search, I did not find any type of clinical trial; therefore, I extracted only retrospective comparative studies and analyzed statistically the results extracted. 

Limitation: Only prospective studies comparing the endoscopy and surgeries therapies with heterogeneity.

Results: Studies comparing surgical and endoscopic therapy showed in the procedure-related mortality, the difference was not significant; in the survival rates after 1, 2, 3, 4, and 5 years were different and showed superiority of surgical therapies over time, these were apparently influenced by biases in selection of population, to remove this bias, endoscopy is superior in control of mortality related to cancer with a high rate of disease recurrence; in regard to comorbidity and mortality associated with the procedure, endoscopy is superior.

Conclusions and implications: There is no evidence from clinical trials. This meta-analysis surgical therapy 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 are superior. Prospective, controlled trials with large sample sizes are required to confirm the results of the current meta-analysis.
Systematic review registration number: CRD42014013170

Keyword: Esophageal Neoplasms, Submucosal esophageal cancer, Surgical

Procedures Operative, Endoscopy Gastrointestinal, Endoscopy, Digestive System.

Related Conferences :

International Conference on Cancer Care and Cure