Original Research Article| Volume 225, ISSUE 3, P508-513, March 2023

A matched cohort comparison of endoscopic resection, chemoradiation and esophagectomy in the treatment of early-stage esophageal squamous cell carcinoma

Published:December 01, 2022DOI:


      • Endoscopic resection for cT1N0M0 squamous cell carcinoma had comparable survival rates to esophagectomy.
      • Esophagectomy and endoscopic resection had a risk-adjusted absolute survival advantage of 27% and 21% relative to CRT.
      • Endoscopic resection was associated with accelerated rates of post-operative recovery but higher rates of R1 resection.



      The efficacy of endoscopic resection in early-stage esophageal squamous cell carcinoma has not been defined.


      We queried the National Cancer Database to identify patients presenting with cT1N0M0 esophageal squamous cell cancer between 2004 and 2017. Transitive match methods were used to 1:1:1 propensity match patients undergoing endoscopic resection to patients undergoing esophagectomy and those undergoing definitive chemoradiotherapy. Kaplan Meier method was used to compare 5-year overall survival profiles for matched cohorts.


      301 patients (19%) underwent endoscopic resection; 497 (32%) esophagectomy; 767 (49%) chemoradiation. On comparison of matched cohorts, patients undergoing chemoradiation demonstrated lower rates of survival than those undergoing esophagectomy (32% vs. 59%, p < 0.0001) while those undergoing endoscopic resection demonstrated rates comparable to patients undergoing esophagectomy (53% vs. 59%, p = 0.77).


      For cT1N0M0 esophageal squamous cell cancer, endoscopic resection is associated with rates of survival similar to those following esophagectomy and better than those following definitive chemoradiation.


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