72218 - Management of early esophageal cancer – a register-based study in Sweden

Introduction Surgery used to be the only way to resect esophageal cancer, but endoscopic treatment has gradually emerged and is now the golden standard in the management of early esophageal cancer. In the Swedish National Registry for Esophageal and Gastric Cancer (NREV) patient has prospectively been registered since 2005. Method We defined early esophagela cancer as cT1N0M0 esophageal cancer and high-grade dysplasia (HGD). We used NREV to investigate type of treatment and the outcome of the treatment 2005-2022. We searched the registry for age, sex, histopathology, type of management and complications. Result 20921 patients are included in the registry. 11217 of them are classified as esophageal cancer. 10045 are classified as advanced cancer (T2-74). Patients classified as TX (1702) are also classified as advanced. 1002 (9.1%) are classified as early cancer. 170 patients were excluded. The mean age in the early cancer group is 70 years. 79% of the patients had early adenocarcinoma (EAC) and 21% had early squamous cell carcinoma (ESCC). 175 patients had missing data of the type of management. 289 underwent endoscopic treatment, 213 underwent surgery and 325 patients were considered palliative or did not get any treatment. Complications were more common in the surgical group, but mortality in association to the procedure was slightly higher in among the endoscopically treated (0.69% vs 0.47%). However, there was no significant statistical difference in overall survival. Discussion Endoscopic treatment has gradually evolved to become the first-line option for early cancer, but surgery may still be an option in some cases.