RADICAL ESOPHAGEAL RESECTION FOR ADENOCARCINOMA ARISING IN BARRETTS-ESOPHAGUS

BACKGROUND: Esophagectomy with extensive lymph node dissection is the best way to give Barrett's patients with locally advanced adenocarcino ma a good chance of cure. MATERIAL AND METHODS: Fifty-five patients un derwent subtotal (n = 47) or distal (n = 8) esophagectomy for Barrett' s adenocarcinoma (n = 43) or high-grade dysplasia (HGD) (n = 12), Thir teen patients (23.6%) never had had any reflux symptom before disclosu re of the neoplastic lesion, and 20 patients (36.4%) had esophageal sh ortening. Ro resections (n = 50) included removal of the esophageal tu be en bloc with the locoregional lymph nodes, RESULTS: An invasive car cinoma was found in the resected specimen of 4 of the 12 patients oper ated on for HGD. Two of the 5 patients whose metaplasia was surveyed e ndoscopically were operated on for an advanced lesion (T2N1, T3N1) bec ause they had not strictly complied with the proposed schedule, One of the 4 patients whose HGD was followed up endoscopically until disclos ure of deeper mucosal invasion had positive lymph nodes at operation, The prevalence of early lesions (Tis, T1, T2, No) was 7.4% in patients with tumor-related symptoms versus 85.7% in those having unrelated sy mptoms (P = 0.0000), which resulted in a 5-year survival rate of 33.8% and 82.4%, respectively (P = 0.0012), Five-year survival rate after R o resection made for invasive carcinoma was 59.3% (all cases), 73.1% ( No), 61.5% (less than or equal to 5 positive lymph nodes), and 0% (>5 positive lymph nodes). CONCLUSIONS: High-grade dysplasia is an indicat ion for esophageal resection. Early detection of the neoplastic transf ormation of Barrett's metaplasia prior to the onset of obstructive sym ptoms gives the best chance of cure, Esophagectomy with radical lymph node clearance is capable of curing a large proportion of the patients having no or a limited number of metastatic lymph nodes. (C) 1997 by Excerpta Medica, Inc.