Endoluminal endoscopic surgery in the treatment of patients with early cardioesophageal junction cancer: a comparative analysis with surgical treatment

Objective. To compare the immediate outcomes, long-term oncological outcomes, and quality of life after endoscopic submucosal dissection and surgery in patients with early cardioesophageal cancer (cTis–cT1N0M0, Siewert type II), and to evaluate the possibility of expanding indications for dissection in comorbid patients. Material and methods. A non-randomized multicenter study included 98 patients (endoscopic treatment — 74, surgery — 24). Due to the low radicality of mucosal resection, only the endoscopic submucosal dissection subgroup (n=55) was compared with surgery. After pseudorandomization, two groups of 24 patients each were formed. We analyzed 5-year overall survival, local control, progression-free survival, complications, hospital stay, and quality of life. Results. Endoscopic submucosal dissection compared with surgery (after pseudorandomization, n=24 each): overall survival 87.5% and 90.5% (p=0.7); local control 95.8% and 94.4% (p=0.98); progression-free survival 95.8% and 90.5% (p=0.58); hospital stay 7 and 11 days (p=0.0002); quality of life (total score of the questionnaire, higher — worse) 0.9 and 7 points (p=0.00002). After surgery, quality of life deteriorated (p=0.02), whereas after dissection it did not change (p=0.371). In 13 comorbid patients (Charlson 7—8, ASA III), dissection was performed according to indications expanded relative to standard criteria (comparison with the standard indication group, n=40): tumor size 20 vs 15 mm, p=0.03; cT1b invasion 92.3% vs 17.5%, p=0.00026; poorly differentiated adenocarcinoma 30.8% vs 5%, p=0.016, respectively. Five-year results (expanded indications vs standard): local control 92.3% vs 97.3% (p=0.36), overall survival 59.1% vs 81.2% (p=0.62), progression-free survival 79.4% vs 97.3% (p=0.008), respectively. Conclusion. Endoscopic submucosal dissection for early cardioesophageal junction cancer is non-inferior to surgery in terms of overall survival, local control, and progression-free survival, while providing a shorter hospital stay and better quality of life. Expanding indications is possible in comorbid patients but requires strict dynamic monitoring.