BARRETTS-CANCER - INDICATIONS, EXTENT, AND RESULTS OF SURGICAL RESECTION

In the Western world, the prevalence of Barrett's carcinoma, i.e., ade nocarcinoma of the distal esophagus arising from specialized columnar epithelial metaplasia, has risen dramatically in the past two decades. High-grade dysplasia in the columnar epithelium has been identified a s the precursor of malignant carcinoma. Whether an esophagectomy shoul d be performed in patients with high-grade dysplasia remains controver sial. Surgical resection is the mainstay of therapy in patients with i nvasive adenocarcinoma who are fit for surgery. Complete removal of th e primary tumor and its lymphatic drainage has to be the primary goal of any surgical approach to adenocarcinoma of the distal esophagus. In patients with tumors located in the distal esophagus, this can be ach ieved by a radical transhiatal esophagectomy and proximal gastric rese ction with en bloc removal of the lymphatic drainage in the lower post erior mediastinum and along the celiac axis. Early adenocarcinoma can be cured by this approach. The value of multimodality therapy in patie nts with advanced tumors needs to be confirmed in well-designed random ized prospective trials. (C) 1997 Wiley-Liss, Inc.