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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

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

This version published: 2012; Review content assessed as up-to-date: April 30, 2012.

Link to full article: [Cochrane Library]

Plain language summary

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

Background: Barrett's oesophagus is one of the most common pre‐malignant 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 since the 1980s. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes. Success of this strategy relies on the fact that late‐stage pre‐malignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: that is conventional open surgery or endotherapy (techniques involving endoscopy).

Objectives: We used data from randomised controlled trials (RCTs) 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 methods: We used the Cochrane highly sensitive search strategy to identify RCTs in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, EBMR, Controlled Trials mRCT and ISRCTN, and LILACS, in July and August 2008. The searches were updated in 2009 and again in April 2012.

Selection criteria: Types of studies: RCTs comparing endotherapies with surgery in the treatment of 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 that 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 that met the inclusion criteria. In total we excluded 13 studies that were not RCTs but that compared surgery and endotherapies.

Authors' conclusions: This Cochrane review has indicated that there are no RCTs 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 HGD.

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Bennett C, Green S, DeCaestecker J, Almond M, Barr H, Bhandari P, Ragunath K, Singh R, Jankowski J. Surgery versus radical endotherapies for early cancer and high‐grade dysplasia in Barrett's oesophagus. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD007334. DOI: 10.1002/14651858.CD007334.pub4. Link to Cochrane Library. [PubMed: 23152243]

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23152243

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