Endoscopic and surgical management of early esophageal cancer: Current evidence and evolving oncologic strategies

Abstract

Early esophageal cancer, defined as disease confined to the mucosa or superficial submucosa, represents a stage at which curative treatment can be achieved with minimally invasive approaches. Historically, esophagectomy was the standard treatment; however, it is associated with substantial morbidity and mortality. Advances in endoscopic techniques, particularly endoscopic mucosal resection and endoscopic submucosal dissection, have shifted management toward organ-preserving strategies in appropriately selected patients. This narrative review provides an updated overview of endoscopic and surgical treatment strategies for early esophageal cancer, with emphasis on risk stratification, clinical decision-making, and interpretation of current evidence. Endoscopic mucosal resection remains suitable for smaller, superficial lesions, whereas endoscopic submucosal dissection enables en bloc resection of larger or more complex lesions with higher rates of complete resection and lower recurrence. Surgical resection continues to play an essential role in patients with submucosal invasion or high-risk histologic features, including lymphovascular invasion and poor differentiation. While endoscopic therapy offers favorable outcomes with reduced morbidity and improved quality of life, these results are largely derived from retrospective studies and high-volume centers, and may not be fully generalizable. Careful patient selection and multidisciplinary evaluation remain critical to optimize treatment outcomes. Future directions include refinement of risk stratification models, integration of advanced imaging and artificial intelligence, and expansion of training programs to support broader adoption of advanced endoscopic techniques.

Keywords: Esophageal cancer; Esophageal squamous cell carcinoma; Esophageal adenocarcinoma; Endoscopic therapy; Endoscopic mucosal resection; Endoscopic submucosal dissection

Core Tip: Early esophageal cancer represents a stage at which curative treatment can be achieved with favorable long-term outcomes. While esophagectomy remains an established oncologic standard, it is associated with substantial morbidity. Growing evidence supports endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection, as effective organ preserving alternatives for carefully selected patients with low risk of lymph node metastasis. Accurate staging and multidisciplinary evaluation are essential to optimize treatment selection. This minireview highlights current evidence comparing endoscopic and surgical strategies and discusses evolving technologies that are reshaping the management paradigm for early esophageal cancer.