SURGICAL-TREATMENT OF BARRETTS CARCINOMA - CORRELATIONS BETWEEN MORPHOLOGIC FINDINGS AND PROGNOSIS

Barrett's carcinoma occurred in 66 of 331 patients with adenocarcinoma s of the esophagus or gastroesophageal junction. Only 32 (46%) of thes e patients had a history of gastroesophageal reflux. A history of alco hol and tobacco abuse was absent in 50% and 47.5%, respectively. The m ean length of Barrett's metaplasia was 7.37 cm. Operability was 98.5% and resectability 95.5%. No postoperative or hospital deaths occurred. Pathologic staging was as follows: stage 0 and I, 38.3%; stage II, 20 .6%; stage III, 22.2%; and stage IV, 19%. Overall survivals were 80.5% at 1 year, 62.7% at 2 years, and 58.2% at 5 years. Five-year survival for patients with stage I disease was 100%; for stage II, 87.5%; for stage III, 22.2%; and for stage IV, 0%. Thirty-four (51.5%) patients w ere under surveillance for a related or unrelated condition before dia gnosis of their carcinoma; only nine (26.5%) had diseased lymph nodes. In 32 the diagnosis was made at their first medical contact, and 78% of them had diseased lymph nodes. Five-year survival without nodal met astasis was 85.3% and significantly better than for patients with meta stasis, 38.3% (p = 0.0033). Of the 66 patients, 19 (28.7%) had a biops y-proved history of Barrett's metaplasia before malignancy developed. Mean time interval between diagnosis of metaplasia and degeneration wa s 3.8 years (89.5% > 1 year). Over the surveillance period, the length of metaplastic Barrett's esophagus remained unchanged in all patients . Barrett's ulceration was present from the beginning in 14 patients, and three patients never had an ulcer. Intestinal metaplasia was seen in 18 patients. Resected specimens revealed severe dysplasia in 16 pat ients. Of the 19 patients, 73.7% had stage I disease. Our data suggest that close endoscopic monitoring and systematic biopsies of the small est irregularities in the metaplastic mucosa may result in early detec tion of carcinoma. In this respect, patients with an ulcer within a zo ne of intestinal metaplasia seem to be at risk. Early detection increa ses substantially the chances for cure by diminishing the risks of lym ph node involvement. Resection remains the treatment of choice in Barr ett's adenocarcinoma including high-grade dysplasia, because mortality can be kept low with excellent to very good functional results in the majority of the patients provided the intervention is performed by ex perienced teams.