ABSTRACT
@#Objective To compare the short- and long-term efficacy of surgery and endoscopy in the treatment of early esophageal cancer by a systematic review and meta-analysis. Methods We extracted data independently from The Cochrane Library, PubMed, EMbase, Web of Science for studies comparing surgery with endoscopy from 2010 to 2020. The primary outcomes including R0 resection rate, long-term overall survival (OS), disease-specific survival (DSS), major complications, recurrence, hospital stay and cost. Meta-analysis was performed using RevMan 5.3 and Engauge Digitizer was used to extract survival curves from relevant literature, and relevant data were calculated based on statistical methods. Results A total of 17 studies involving 3 705 patients were included. It was found that patients in the surgery group had a higher R0 resection rate compared with the endoscopic group (OR=0.13, 95%CI 0.07 to 0.27, P<0.001, I2=6%). The total complications rate of resection of esophageal cancer was higher than that of the endoscopic group (OR=0.28, 95%CI 0.16 to 0.50, P<0.001, I2=68%). The length of hospitalization in the endoscopic group was obviously shorter than that in the surgery group (MD=–8.28, 95%CI –12.44 to –4.13, P<0.001, I2=96%). The distant recurrence rate (OR=0.58, 95%CI 0.24 to 1.41, P=0.230, I2=0%) and the local recurrence rate after resection (OR=1.74, 95%CI 0.66 to 4.59, P=0.260, I2=40%) in the endoscopic group was similar to those of the surgery group. There was no significant difference in 5 year-OS rate between the two groups (HR=0.86, 95%CI 0.67 to 1.11, P=0.25, I2=0%), which was subdivided into two groups: adenocarcinoma (HR=0.55, 95%CI 0.15 to 2.05, P=0.37, I2=0%) and squamous cell carcinoma (HR=0.68, 95%CI 0.46 to 1.01, P=0.06, I2=0%), showing that there was no difference between the two subgroups. There was no significant difference in the DSS rate (HR=0.72, 95%CI 0.49 to 1.05, P=0.090, I2=0%) between the two groups. The cost of the surgery group was significantly higher than that of the endoscopic group (MD=–12.97, 95%CI –18.02 to –7.92, P<0.001, I2=93%). Conclusion The evidence shows that endotherapy may be an effective treatment for early esophageal neoplasm when considering the long-term outcomes whether it is squamous or adenocarcinoma, even though it is not as effective as surgery in the short-term efficacy.