Endoscopic Versus Surgical Management of Early-stage Oesophageal Cancer: A Comprehensive Meta-Analysis on Survival

Introduction: Treatment decision-making for oesophageal cancer is particularly challenging when the disease is in its early stages, contributing significantly to the worldwide health burden. Endoscopic procedures have become popular as less intrusive substitutes for surgery in the treatment of oesophageal cancer in its early stages. The objective of this systematic review is to assess and compare, in patients with early-stage oesophageal cancer, the long-term survival and complication outcomes of endoscopic versus surgical therapy. Methodology: Using electronic databases (PubMed, Scopus, Web of Science and Cochrane Library), a thorough literature search was carried out to find pertinent published research. Research comparing surgical resection with endoscopic procedures (endoscopic submucosal dissection and endoscopic mucosal resection) for early-stage oesophageal cancer was encompassed. We gathered and evaluated data on overall survival, death and complications. Results: A total of 30 studies met the inclusion criteria and were included in the review. The studies encompassed a diverse range of patient populations and interventions, with varying follow-up periods. Overall, endoscopic interventions were associated with comparable long-term survival outcomes to surgical resection, with significant differences in overall mortality rates, complications and long-term survival rates observed between the two treatment modalities: odds ratio (OR) =0.426, 95% confidence interval (CI): 0.293–0.617, P < 0.001 and OR = 0.713, 95% CI: 0.581–0.875, P = 0.001, respectively. However, endoscopic interventions were associated with lower rates of complications (OR = 0.270, 95% CI: 0.185–0.394, P < 0.001) compared to surgery. Conclusion: Endoscopic interventions are effective in early-stage oesophageal cancer treatment, with comparable long-term survival compared to surgical resection. However, further research is needed to determine the most suitable treatment strategy.