Operative treatment of Barrett-carcinoma

Barrett-carcinoma is a type of adenocarcinoma of the distal esophagus and t he cardia. Barrett-esophagus is defined by the histologic presence of speci alized epithelium with intestinal metaplasia. As a consequence Barrett-carc inoma has a close relationship to the adenocarcinoma of the cardia and is v ery often part of the cardiacarcinoma type I. The aim of the surgical thera py is a radical RO-resection of the tumor including the lymphatic drainage area. This aim is accomplished among different authors by different surgica l concepts. One is the radical transhiatal subtotal esophagectomy with lymp hadenectomy in the lower mediastinum and the upper abdominal compartments. The other concept is a transthoracic en-bloc esophagectomy. Both resection procedures are usually completed by gastric pull up reconstruction. Currently a sophisticated preoperative staging is followed by distinguished indication and therapy depending on tumor status, risk factors of the pati ent and on the international classification of the cardia carcinoma (Siewer t). When a RO-resection is impossible, a neoadjuvant radiochemotherapy shou ld be performed.