ADENOCARCINOMA IN THE DISTAL ESOPHAGUS WITH AND WITHOUT BARRETT-ESOPHAGUS - DIFFERENCES IN SYMPTOMS AND SURVIVAL RATES

Objective: To evaluate differences in clinical appearance and survival rates in patients operated on for adenocarcinoma in the distal esopha gus with and without Barrett epithelium. Design: Prospective clinical study. Setting: University hospital, Sweden. Patients: Fifty-four pati ents with adenocarcinoma in the distal esophagus with (n=17) or withou t (n=37) Barrett epithelium. Intervention: Esophagectomy or total gast rectomy. Main Outcome Measures: Preoperative symptoms, endoscopic resu lts, and histological findings; postoperative morbidity, mortality, an d survival rates. Results: The main indication for the endoscopic exam ination that revealed tumor in the group with Barrett esophagus was re flux-related symptoms in 6 patients (routine Barrett examination, n=4; symptoms of reflux, n=2), symptoms related to upper gastrointestinal tract bleeding in 6, and malignant symptoms in 5 (dysphagia, n=4; weig ht loss, n=1). In contrast, most patients in the cardia cancer group w ere admitted because of malignant symptoms (dysphagia, n=26; epigastri c pain, n=9; and anemia, n=2). Ten of 17 patients in the Barrett esoph agus cancer group had tumors limited to the mucosa and submucosa only. In 1 patient the tumor grew into the muscular layer but not through i t. In the remaining 6 patients the tumor did grow through the muscular layer and lymph node metastases were found. Wall penetration was foun d in 30 patients and metastases to lymph nodes in 29 patients in the c ardia cancer group. The hospital mortality rate was 0 of 1.7 patients in the Barrett cancer group and 2 of 37 patients in the cardia cancer group. In the patients operated on for adenocarcinoma in the distal es ophagus, a better long-term survival rate was seen in those with Barre tt epithelium (50%) than in those without this metaplasia (10%) (log r ank P=.005; chi(2)=7.80). Conclusions: Concomitant Barrett epithelium improved the prognosis for patients with adenocarcinoma in the distal esophagus. Probably the reason for this was a higher rate of early-sta ge disease, because symptoms of gastroesophageal reflux and other beni gn disorders, not dysphagia, were most common in patients with adenoca rcinoma without Barret epithelium in the distal esophagus.