World Journal of Surgery

, Volume 27, Issue 9, pp 1062–1066 | Cite as

Results of Surgical Therapy in Patients with Barrett’s Adenocarcinoma

  • Luigi BonavinaEmail author
  • Albert Via
  • Raffaello Incarbone
  • Greta Saino
  • Alberto Peracchia
World Progress in Surgery


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.


Esophageal Adenocarcinoma Disseminate Tumor Cell Esophagogastric Anastomosis Peritoneal Carcinosis Early Stage Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Thomas, P, Doddoli, C, Lienne, N,  et al. 1997Changing patterns and surgical results in adenocarcinoma of the oesophagusBr. J. Surg.84119125Google Scholar
  2. 2.
    Devesa, S, Blot, W, Fraumeni, J 1998Changing patterns in the incidence of esophageal and gastric carcinoma in the United StatesCancer8320492053Google Scholar
  3. 3.
    DeMeester, S, DeMeester, T 2000Columnar mucosa and intestinal metaplasia of the esophagus. Fifty years of controversyAnn. Surg.231303321Google Scholar
  4. 4.
    Incarbone, R, Bonavina, L, Szachnowicz, S,  et al. 2000Rising incidence of esophageal adenocarcinoma in Western countries: is it possible to identify a population at risk?Dis. Esoph.13275278Google Scholar
  5. 5.
    Siewert, J, Holscher, A, Becker, K,  et al. 1987Kardiakarzinom: Versuch einer therapeutisch relevanten KlassifikationChirurg582534Google Scholar
  6. 6.
    Siewert, R, Feith, M, Werner, M,  et al. 2000Adenocarcinoma of the esophagogastric junction. Results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patientsAnn. Surg.232353361CrossRefPubMedGoogle Scholar
  7. 7.
    Bonavina, L, Peracchia, A 1999Anastomosi esofagoviscerale cervicale con suturatrice lineare endoscopica. Nota di tecnica chirurgicaMinerva Chir.54725728Google Scholar
  8. 8.
    Orringer, M, Marshall, B, Iannettoni, M 2000Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosisJ. Thorac. Cardiovasc. Surg.119277286Google Scholar
  9. 9.
    Jobin, L, Wittekind, C, editors (1997) TNM Classification of Malignant Tumors, 5th edition, Wiley-Liss, New YorkGoogle Scholar
  10. 10.
    Bonavina, L, Ferrero, S, Midolo, V,  et al. 1999Lymph node micrometastases in patients with adenocarcinoma of the esophagogastric junctionJ. Gastrointest. Surg.3468476Google Scholar
  11. 11.
    Bonavina, L, Soligo, D, Quirici, N,  et al. 2001Bone marrow disseminated tumor cells in patients with carcinoma of the esophagus or cardiaSurgery1291522CrossRefPubMedGoogle Scholar
  12. 12.
    Provenzale, D, Kemp, J, Arora, S,  et al. 1994A guide for surveillance of patients with Barrett’s esophagusAm. J. Gastroenterol.89670680Google Scholar
  13. 13.
    Peters, J, Clark, G, Ireland, A,  et al. 1994Outcome of adenocarcinoma arising in Barrett’s esophagus in endoscopically surveyed and nonsurveyed patientsJ. Thorac. Cardiovasc. Surg.108813822Google Scholar
  14. 14.
    Anderson, D, Campbell, S, Park, K 1996Accuracy of laparoscopic ultrasonography in the staging of upper gastrointestinal malignancyBr. J. Surg.8314241428PubMedGoogle Scholar
  15. 15.
    Bonavina, L, Incarbone, R, Lattuada, E,  et al. 1997Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junctionJ. Surg. Oncol.65171174CrossRefPubMedGoogle Scholar
  16. 16.
    Hagen, J, Peters, J, Meester, T,  et al. 1993Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardiaJ. Thorac. Cardiovasc. Surg.106850859PubMedGoogle Scholar
  17. 17.
    Holscher, A, Elfriede, E, Bumm, R,  et al. 1995Prognostic factors of resected adenocarcinoma of the esophagusSurgery118845855PubMedGoogle Scholar
  18. 18.
    Lerut, T, Coosemans, W, Raemdonck, D,  et al. 1994Surgical treatment of Barrett’s carcinoma. Correlations between morphologic findings and prognosisJ. Thorac. Cardiovasc. Surg.10710591066Google Scholar
  19. 19.
    Collard, J, Romagnoli, R, Hermons, B,  et al. 1997Radical esophageal resection for adenocarcinoma arising in Barrett’s esophagusAm. J. Surg.174307311CrossRefPubMedGoogle Scholar
  20. 20.
    Clark, G, Peters, J, Ireland, A,  et al. 1994Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinomaAnn. Thorac. Surg.58646654Google Scholar
  21. 21.
    Altorki, N, Skinner, D 1997Occult cervical nodal metastasis in esophageal cancer: preliminary results of three-field lymphadenectomyJ. Thorac. Cardiovasc. Surg.113540544PubMedGoogle Scholar
  22. 22.
    Bumm, R, Feussner, H, Bartels, H,  et al. 1997Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinomaWorld J. Surg.21822831Google Scholar
  23. 23.
    Peracchia, A, Bonavina, L, Segalin, A,  et al. 1994Esophagectomy without thoracotomy or transmediastinal endodissection for esophageal carcinoma?Dis. Esoph.73638Google Scholar
  24. 24.
    Walsh, T, Noonan, N, Hollywood, D 1996A comparison of multimodal therapy and surgery for esophageal adenocarcinomaN. Engl. J. Med.335462467Google Scholar
  25. 25.
    Maehara, Y, Oshiro, T, Baba, H 1996Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrenceSurgery119397402Google Scholar
  26. 26.
    O’Sullivan, G, Sheehan, D, Clarke, A 1999Disseminated tumor cells in esophagogastric cancer: high detection rate in resected rib segmentsGastroenterology116543548Google Scholar

Copyright information

© Société Internationale de Chirurgie 2003

Authors and Affiliations

  • Luigi Bonavina
    • 1
    Email author
  • Albert Via
    • 1
  • Raffaello Incarbone
    • 1
  • Greta Saino
    • 1
  • Alberto Peracchia
    • 1
  1. 1.Department of SurgeryUniversity of Milano, Istituto Policlinico San DonatoSan Donato Milanese (Milano)Italy

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