Summary Background To assess the outcomes of patients with early esophageal cancer and high-grade dysplasia comparing esophagectomy, the historical treatment of choice, to endoscopic eradication therapy (EET). Methods Retrospective cohort study of consecutive patients with early esophageal cancer/high-grade dysplasia, treated between 2000 and 2018 at a tertiary center. Primary outcomes were all-cause and disease-specific mortality assessed by multivariable Cox regression and a propensity score matching sub analysis, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, tumor grade (G1/2 vs. G3), tumor stage, and lymphovascular invasion. Secondary outcomes included complications, hospital stay, and overall costs. Results Among 269 patients, 133 underwent esophagectomy and 136 received EET. Adjusted survival analysis showed no difference between groups regarding all-cause mortality (HR 1.85, 95% CI 0.73, 4.72) and disease-specific mortality (HR 1.10, 95% CI 0.26, 4.65). In-hospital and 30-day mortality was 0% in both groups. The surgical group had a significantly higher rate of complications (Clavien–Dindo ≥3 26.3% vs. endoscopic therapy 0.74%), longer in-patient stay (median 14 vs. 0 days endoscopic therapy) and higher hospital costs(£16 360 vs. £8786 per patient). Conclusion This series of patients treated during a transition period from surgery to EET, demonstrates a primary endoscopic approach does not compromise oncological outcomes with the benefit of fewer complications, shorter hospital stays, and lower costs compared to surgery. It should be available as the gold standard treatment for patients with early esophageal cancer. Those with adverse prognostic features may still benefit from esophagectomy.

中文翻译：

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早期食管癌从食管切除术过渡到内镜治疗

摘要背景 为了评估早期食管癌和重度不典型增生患者的结果，将食管切除术（历史上的首选治疗）与内镜根除治疗 (EET) 进行比较。方法对 2000 年至 2018 年间在一家三级中心接受治疗的早期食管癌/重度不典型增生患者进行回顾性队列研究。主要结果是通过多变量 Cox 回归和倾向评分匹配子分析评估的全因和疾病特异性死亡率，提供风险比 (HR) 和针对年龄、肿瘤等级 (G1/2 与G3)、肿瘤分期和淋巴血管侵犯。次要结局包括并发症、住院时间和总费用。结果 269例患者中，133例行食管切除术，136例行EET。调整后的生存分析显示，各组之间在全因死亡率（HR 1.85, 95% CI 0.73, 4.72）和疾病特异性死亡率（HR 1.10, 95% CI 0.26, 4.65）方面没有差异。两组的住院和 30 天死亡率均为 0%。手术组的并发症发生率显着更高（Clavien-Dindo ≥3 26.3% vs. 内镜治疗 0.74%），住院时间更长（中位 14 天 vs. 0 天内镜治疗）和更高的住院费用（16 360 英镑 vs. . 每位患者 8786 英镑）。结论 这一系列在从手术到 EET 的过渡期间接受治疗的患者表明，与手术相比，初级内窥镜方法不会影响肿瘤学结果，具有更少的并发症、更短的住院时间和更低的成本。它应该成为早期食管癌患者的金标准治疗方法。