SURGERY VERSUS ENDOSCOPIC THERAPIES FOR EARLY CANCER AND HIGH-GRADE DYSPLASIA IN THE ESOPHAGUS: a systematic review

Abstract

There is no evidence from clinical trials. In this systematic review, surgical therapies showed superiority for survival, and endoscopic therapies showed superiority in the control of mortality related to cancer with a high rate of disease recurrence; also, for the comorbidity and the mortality associated with the procedure, endoscopy is superior. Prospective, controlled trials with large sample sizes are necessary to confirm the results of the current analysis.

Photodynamic therapy for solid tumors: A review of the literature

“…Adverse effects of PDT in treatment have been reported as strictures, skin phototoxicity, chest pain, and nausea, but in general, endoscopic procedures have less morbidity and mortality than surgery. Despite this, retrospective studies show that neoplastic recurrence may be higher with PDT than with surgery …”

“…Despite this, retrospective studies show that neoplastic recurrence may be higher with PDT than with surgery. 35,36 As palliative treatment, stenting is still more commonly used for treatment of dysphagia in end-stage esophageal cancer; however, PDT plays a large role in patients who cannot tolerate stents due to severe pain or post-radiotherapy and has been shown to have a favorable survival outcome compared to other interventions when used initially. 37 The largest study of palliative PDT for 215 affected patients reported improved dysphagia in 85%, achieving an average of 4.8 months of overall survival and a median of 2 months of dysphagia relief.…”

Endoscopic Probe for Ultrasound-Assisted Photodynamic Therapy of Deep-Lying Tissue

“…In addition to diagnosis, treatment can be performed with an endoscope, which is called therapeutic endoscopy [3]. Compared to traditional surgery requiring a large incision, therapeutic endoscopy has low complications and mortality related to surgical procedure [4], and it is suitable for simultaneous diagnosis and therapy [5]. For these reasons, therapeutic endoscopy has been in the spotlight as a noninvasive or minimally invasive theragnostic tool, especially, for cancer occurring in the organs of the digestive system such as the gastrointestinal, colon, duodenum, and pancreas, where a therapeutic endoscope is easily accessible; endoscopic mucosal resection (EMR), endoscopic polypectomy, and endoscopic submucosal dissection (ESD) are the typical examples of therapeutic endoscopy [6], [7].…”

“…For these reasons, therapeutic endoscopy has been in the spotlight as a noninvasive or minimally invasive theragnostic tool, especially, for cancer occurring in the organs of the digestive system such as the gastrointestinal, colon, duodenum, and pancreas, where a therapeutic endoscope is easily accessible; endoscopic mucosal resection (EMR), endoscopic polypectomy, and endoscopic submucosal dissection (ESD) are the typical examples of therapeutic endoscopy [6], [7]. However, these methods have a risk of complications such as perforation and hemorrhage and a high possibility of recurrence due to incomplete incision [4], [7]- [9]. Endoscopic photodynamic therapy (PDT) has attracted much attention as a viable solution to the aforementioned problems of therapeutic endoscopy [10], [11].…”