Results of Surgical Therapy in Patients with Barrett’s Adenocarcinoma

The incidence of adenocarcinoma arising from Barrett’s esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma...

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Bibliographic Details
Published in:World journal of surgery 2003-09, Vol.27 (9), p.1062-1066
Main Authors: Bonavina, Luigi, Via, Albert, Incarbone, Raffaello, Saino, Greta, Peracchia, Alberto
Format: Article
Language:English
Subjects:
Adenocarcinoma - etiology
Adenocarcinoma - mortality
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Barrett Esophagus - complications
Barrett Esophagus - mortality
Barrett Esophagus - surgery
Disseminate Tumor Cell
Early Stage Carcinoma
Esophageal Adenocarcinoma
Esophageal Neoplasms - etiology
Esophageal Neoplasms - mortality
Esophageal Neoplasms - surgery
Esophagectomy
Esophagogastric Anastomosis
Female
Humans
Lymph Node Excision
Male
Middle Aged
Peritoneal Carcinosis
Retrospective Studies
Survival Rate
Treatment Outcome
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Summary:The incidence of adenocarcinoma arising from Barrett’s esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma of the esophagogastric junction were observed in our institution. Of these, 105 (31.8%) had Barrett’s carcinoma. In 12 individuals (11.4%) adenocarcinoma was discovered during endoscopic surveillance for Barrett’s esophagus. Twelve patients with doubtful cleavage planes at preoperative investigation were treated with neoadjuvant chemotherapy. Overall, 80 patients (76.2%) underwent esophagectomy without operative mortality. The Ivor Lewis approach was used in 70 patients; of these, 31 underwent extended mediastinal lymph node dissection. Seventy‐four patients (92.5%) had R0 resection. The overall 5‐year survival rate was 48%. Survival was significantly associated with stage, lymph node status, and completeness of resection. Early diagnosis remains the prerequisite for curative treatment of esophageal carcinoma. An extended mediastinal lymphadenectomy does not increase morbidity, allows precise tumor staging, and may prove effective in preventing local recurrences. Neoadjuvant therapy requires major improvement before it can be unconditionally recommended outside clinical trials.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-003-7062-0