Surgical and endoscopic management of high grade dysplasia and early XXXX .

@entity1 @entity1893 @entity420 @entity5
BACKGROUND: The introduction of endoscopic techniques has led to debate about optimal management of early @entity420 . The aim was to evaluate @entity1 selection and outcomes for endoscopic or surgical treatment at a tertiary referral centre. METHODS: A prospectively collected database of consecutive @entity1 staged with @entity1893 ( @entity1893 ) or T1 @entity420 treated with curative intent between 2005 and 2013 was undertaken. All @entity1 were discussed at the multidisciplinary team meeting. Surgical treatment was by thoracoscopic assisted or standard/laparoscopic assisted Ivor Lewis oesophagectomy. Endoscopic treatment was a structured programme of endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA). Outcomes included treatment variables, recurrence and complications. RESULTS: 83 @entity1 treated; 50 with endoscopic therapy (EMR only-4, EMR then RFA-22, RFA only-24) and 38 by surgery (33 straight to surgery and 5 following EMR). Median age (67) and mean follow-up (21 months) were similar. @entity1893 was more common in the endoscopic group (32/50, 64%, vs.3/33, 9%, p  =  0.0001). Significant complications were more common following surgery (13/38, 34%, vs. 1/50, 2%, p  =  0.0001). There were two in-hospital deaths following oesophagectomy (1 open, 1 thoracoscopic). Endoscopic treatment beyond 12 months for persisting @entity1893 was required in 2 @entity1 . Recurrence of @entity1893 /invasive @entity5 was diagnosed in 2/36 (5.6%, T1a recurrence) of endoscopic and 1/38 (2.6%, T2N0 - subsequent hepatic metastases) surgical @entity1 . CONCLUSION: A management algorithm including both endoscopic treatment and oesophagectomy provides optimal outcome for these @entity1 . Due to additional morbidity of surgery, endoscopic treatment is appropriate first-line treatment.
