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Surgery for Barrett’s Esophagus: From Metaplasia to Cancer

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Surgical Management of Benign Esophageal Disorders

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Abstract

This chapter reviews the management of patient with Barrett’s esophagus, from metaplasia to high-grade dysplasia and intramucosal cancer.

Anti-reflux surgery may be indicated in symptomatic patients with metaplasia. However, there is no evidence that it prevents progression to dysplasia and cancer so that postoperative surveillance is recommended.

Endoscopic techniques (radiofrequency ablation and endoscopic mucosal resection) are used for most patients with high-grade dysplasia and intramucosal (T1a) cancers, while an esophagectomy is indicated for more advanced stages of the cancer.

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References

  1. Sharma P, et al. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology. 2004;127:310–30.

    Article  PubMed  Google Scholar 

  2. O’Connor JB, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrett’s esophagus. Am J Gastroenterol. 1999;94:2037–42.

    PubMed  Google Scholar 

  3. Wang KK. Current strategies in the management of Barrett’s esophagus. Curr Gastroenterol Rep. 2005;7:196–201.

    Article  CAS  PubMed  Google Scholar 

  4. Spechler SJ. The natural history of dysplasia and cancer in esophagitis and Barrett esophagus. J Clin Gastroenterol. 2003;36:S2–5.

    Article  PubMed  Google Scholar 

  5. Sharma P. Controversies in Barrett’s esophagus: management of high grade dysplasia. Semin Gastrointest Dis. 2001;12:26–32.

    CAS  PubMed  Google Scholar 

  6. Reid BJ, et al. Predictors of progression of cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low and high-risk patient subsets. Am J Gastroenterol. 2000;95:1669–76.

    CAS  PubMed  Google Scholar 

  7. Morrow EH, Oelschlager BK. Barrett’s esophagus. CDS Surgery online resource; 2012.

    Google Scholar 

  8. Oelschlager BK, et al. Clinical and pathologic response of Barrett’s esophagus to laparoscopic anti-reflux surgery. Ann Surg. 2003;238:458–66.

    PubMed  Google Scholar 

  9. Wassenaar E, Oelschlager BK. Effect of medical and surgical treatment of Barrett’s metaplasia. World J Gastroenterol. 2010;16(30):3773–9.

    Article  PubMed  Google Scholar 

  10. Oelschlager BK, Pellegrini CA. Laparoscopic treatment of Barrett’s esophagus. Adv Surg. 2004;38:1–12.

    PubMed  Google Scholar 

  11. Milind R, Attwood SE. Natural history of Barrett’s esophagus. World J Gastroenterol. 2012;18(27):3483–91.

    Article  PubMed  Google Scholar 

  12. Chang EY, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with Barrett esophagus, a systematic review. Ann Surg. 2007;246:11–21.

    Article  PubMed  Google Scholar 

  13. Parrilla P, et al. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg. 2003;237:291–8.

    PubMed  Google Scholar 

  14. Rees JRE, Lao-Sirieix P, Wong A, Fitzgerald RC. Treatment for Barrett’s oesophagus. Cochrane Database Syst Rev. 2010(1):CD004060. doi: 10.1002/14651858.CD004060.pub2. Review.

  15. Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–52.

    Google Scholar 

  16. Bennett C, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology. 2012;143:336–46.

    Article  PubMed  Google Scholar 

  17. Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57:1200–6.

    Article  CAS  PubMed  Google Scholar 

  18. Dunbar KB, Spechler SJ. The risk of lymph node metastases in patients with high grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2012;107(6):850–63.

    Article  PubMed  Google Scholar 

  19. Leers JM, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg. 2011;253:271–8.

    Article  PubMed  Google Scholar 

  20. Collard JM. High-grade dysplasia in Barrett’s esophagus. Chest Surg Clin N Am. 2002;12:77–92.

    Article  PubMed  Google Scholar 

  21. Pennathur A, Landreneau RJ, Luketich JD. Surgical aspects of the patient with high-grade dysplasia. Semin Thorac Cardiovasc Surg. 2005;17:326–32.

    Article  PubMed  Google Scholar 

  22. Nguyen NT, Dholakia C, Nguyen XM, Reavis K. Outcomes of minimally invasive esophagectomy without pyloroplasty; analysis of 109 cases. Am Surg. 2010;76(10):1135–8.

    PubMed  Google Scholar 

  23. Urschel JD, et al. Pyloric drainage or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg. 2002;19:160–4.

    Article  PubMed  Google Scholar 

  24. Martin JT, Federico JA, McKelvey AA, et al. Prevention of delayed gastric emptying after esophagectomy: a single center’s experience with botulinum toxin. Ann Thorac Surg. 2009;87(6):1708–13.

    Article  PubMed  Google Scholar 

  25. Tabira Y, Sakaguchi T, Kuhara H, et al. The width of a gastric tube has no impact on outcome after esophagectomy. Am J Surg. 2004;187:417–21.

    Article  PubMed  Google Scholar 

  26. McCaughan JS, Litle VR, Schaur PR, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238:486–94.

    PubMed  Google Scholar 

  27. Orringer MB. Transhiatal esophagectomy without thoracotomy. In: Mastery of surgery. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 772–88.

    Google Scholar 

  28. Orringer MB, Sloan H. Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg. 1978;76:643.

    CAS  PubMed  Google Scholar 

  29. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastamosis. J Thorac Cardiovasc Surg. 2000;119:277.

    Article  CAS  PubMed  Google Scholar 

  30. Law S, Wong J. Esophagogastrectomy for carcinoma of the esophagus and gastric cardia, and the esophageal anastamosis. In: Mastery of surgery. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 752–71.

    Google Scholar 

  31. Nguyen NT, et al. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg. 2008;248:1081–91.

    Article  PubMed  Google Scholar 

  32. Zhang J, Wang R, Liu S, et al. Refinement of minimally invasive esophagectomy techniques after 15 years of experience. J Gastrointest Surg. 2012;16:1768–74.

    Article  PubMed  Google Scholar 

  33. Deb SJ, Shen KR, Deschamps C. An analysis of esophagectomy and other techniques in the management of high-grade dysplasia of Barrett’s esophagus. Dis Esophagus. 2012;25:356–66.

    Article  CAS  PubMed  Google Scholar 

  34. Rentz J, Bull D, Harpole D, et al. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg. 2003;125:1114–20.

    Article  PubMed  Google Scholar 

  35. Chang AC, Hong J, Birkmeyer NJ, et al. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg. 2008;85:424–9.

    Article  PubMed  Google Scholar 

  36. Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.

    Article  CAS  PubMed  Google Scholar 

  37. Migliore M, Choong CK, Lim E, et al. A surgeon’s case volume of oesophagectomy for cancer strongly influences the operative mortality rate. Eur J Cardiothorac Surg. 2007;32:375–80.

    Article  PubMed  Google Scholar 

  38. Lagarde SM, Vrouenraets BC, Stassen LPS, van Lanschot JJB. Evidence-based surgical treatment of esophageal cancer: overview of high-quality studies. Ann Thorac Surg. 2010;89:1319–26.

    Article  PubMed  Google Scholar 

  39. Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation and detection. Ann Thorac Surg. 2009;88:177–85.

    Article  PubMed  Google Scholar 

  40. Uttley L, Campbell F, Rhodes M, et al. Minimally invasive oesophagectomy versus open surgery: is there an advantage? Surg Endosc. 2013;27:724–31.

    Article  PubMed  Google Scholar 

  41. Sudarshan M, Ferri L. A critical review of minimally invasive esophagectomy. Surg Laparosc Endosc Percutan Tech. 2012;22(4):310–8.

    Article  PubMed  Google Scholar 

  42. Teoh AY, Chiu PW, Wong TC, et al. Functional performance and quality of life in patients with squamous esophageal carcinoma receiving surgery or chemoradiation. Results from a randomized trial. Ann Surg. 2011;253(1):6–7.

    Article  Google Scholar 

  43. Orringer MB. Defining a “successful” esophagectomy. Ann Surg. 2011;253:6–7.

    Article  PubMed  Google Scholar 

  44. Chang LC, Oelschlager BK, Quiroga E, Parra JD, Mulligan M, Wood DE, Pellegrini CA. Long-term outcome of esophagectomy for high-grade dysplasia or cancer found during surveillance for Barrett’s esophagus. J Gastrointest Surg. 2006;10(3):341–6.

    Article  PubMed  Google Scholar 

  45. Zeng J, Liu JS. Quality of life after three kinds of esophagectomy for cancer. World J Gastroenterol. 2012;18(36):5106–13.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington, Seattle, WA, USA

    Ellen H. Morrow MD & Brant K. Oelschlager MD

Authors
  1. Ellen H. Morrow MD
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  2. Brant K. Oelschlager MD
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Corresponding author

Correspondence to Brant K. Oelschlager MD .

Editor information

Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    P. Marco Fisichella

  2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Nathaniel J. Soper

  3. Department of Surgery, University of Washington Medical Center, Seattle, USA

    Carlos A. Pellegrini

  4. Chicago, Illinois, USA

    Marco G. Patti

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© 2014 Springer-Verlag London

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Morrow, E.H., Oelschlager, B.K. (2014). Surgery for Barrett’s Esophagus: From Metaplasia to Cancer. In: Fisichella, P., Soper, N., Pellegrini, C., Patti, M. (eds) Surgical Management of Benign Esophageal Disorders. Springer, London. https://doi.org/10.1007/978-1-4471-5484-6_16

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  • DOI: https://doi.org/10.1007/978-1-4471-5484-6_16

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5483-9

  • Online ISBN: 978-1-4471-5484-6

  • eBook Packages: MedicineMedicine (R0)

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