Endoscopic resection versus esophagectomy for T1bN0M0 esophageal cancer: a systematic review and meta-analysis
In brief
5-year survival is similar after endoscopic resection versus esophagectomy for T1b esophageal cancer
A meta-analysis of ten retrospective studies (2,491 patients) found no meaningful difference in five-year overall or cancer-specific survival, recurrence rates, or 30-day mortality between endoscopic resection (EMR/ESD) and surgical esophagectomy for T1bN0M0 disease. Evidence is limited by high bias, so randomized trials are still needed.
- Journal
- Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (Q1)
- Published
- 2 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Nader M Hanna, Bright Huo, Zuhaib M Mir, John Agzarian
- PMID
- 42580677
- DOI
- 10.1093/dote/doag083
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 16 August 2026): Endoscopic resection vs esophagectomy for T1b esophageal cancer, meta‑analysis
- Picked for Surgery (paper of the day, 14 August 2026).
Abstract
Esophagectomy remains the standard of care for T1b esophageal cancer. Guidelines support the use of endoscopic resection (ER) including endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in carefully selected patients. We compared patients with T1b esophageal cancer who underwent ER or esophagectomy. We searched MEDLINE, EMBASE and CENTRAL from inception to November 2025 for studies comparing esophagectomy and ER for patients with T1b esophageal cancer. We excluded studies if patients received neoadjuvant or adjuvant treatment. Outcomes were 5-year overall survival (OS) and cancer specific survival (CSS), recurrence, and mortality. Meta-analysis (with propensity-matched data when available) was performed, with a subgroup analysis of ESD versus esophagectomy. Ten retrospective studies were identified comprising 2491 patients who underwent ER (n = 890) or esophagectomy (n = 1601). Mean age was 65.7 years with 16.1% female. Six studies grouped EMR and ESD together, three reported ESD alone, one examined EMR only. OS and CSS were available in seven and four studies, respectively. There was no significant difference between esophagectomy and ER regarding 5-year OS (HR 1.26; 95% CI 1.00-1.60; P = 0.05), 5-year CSS (HR 0.65; 95% CI 0.20-2.17; P = 0.49), and 30-day mortality (HR 0.39; 95% CI 0.13-1.16; P = 0.09). Recurrence was 18.1% after esophagectomy and 17.7% after ER. Subgroup analysis showed no difference in OS or mortality. Risk of bias was high in five studies. Available retrospective comparative evidence suggests no clear difference between ER and esophagectomy for patients with T1b esophageal cancer. Randomized controlled trials are needed to reduce patient heterogeneity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.