Skip to main content
SpringerLink
Log in

Surgical Treatment of High-Grade Dysplasia and Early Esophageal Cancer

  • Surgical Symposium Contribution
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The treatment of early-stage esophageal cancer and high-grade dysplasia of the esophagus has changed significantly in recent years. Many early tumors that were traditionally treated with esophagectomy can now be resected with endoscopic therapy alone. These new endoscopic modalities can offer similar survival outcomes without the associated morbidity of a major operation. However, a number of these cases may still require surgical intervention as the best treatment option.

Methods

The current scientific literature, national and international guidelines were reviewed for recommendations regarding optimal treatment of early esophageal malignancy.

Results

The primary advantage of surgery over endoscopic treatment lies in the reduced risk of recurrence as well as the ability to assess harvested lymph nodes for regional disease. We recommend that esophageal tumors that have invaded into the submucosa (T1b) or beyond should be treated with an esophagectomy. In addition, dysplastic lesions and cancers that demonstrate poorly differentiated pathology or lymphovascular or perineural invasion should be surgically resected. Finally, large tumors, multifocal lesions, tumors within a long segment of Barrett’s esophagus, tumors adjacent to a hiatal hernia, tumors that cannot be resected enbloc with endoscopic techniques should also be treated with an esophagectomy.

Conclusions

When performed at high-volume centers in experienced hands, esophagectomy can have consistently good outcomes for high-grade dysplasia and early esophageal cancers, and should be considered as a treatment option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Howlader NNA, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (2015) SEER cancer statistics review, 1975–2012. Secondary SEER cancer statistics review, 1975–2012 24 January 2016 http://seer.cancer.gov/csr/1975_2012/

  2. Stein HJ, Feith M, Bruecher BL et al (2005) Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 242(4):566–573 (discussion 73–5)

    PubMed  PubMed Central  Google Scholar 

  3. Pacifico RJ, Wang KK, Wongkeesong LM et al (2003) Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol 1(4):252–257

    Article  PubMed  Google Scholar 

  4. Pech O, Bollschweiler E, Manner H et al (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254(1):67–72

    Article  PubMed  Google Scholar 

  5. Prasad GA, Wang KK, Buttar NS et al (2007) Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 132(4):1226–1233

    Article  PubMed  PubMed Central  Google Scholar 

  6. Prasad GA, Wu TT, Wigle DA et al (2009) Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 137(3):815–823

    Article  PubMed  Google Scholar 

  7. Reed MF, Tolis G, Edil BH et al (2005) Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 79(4):1110–1115 (discussion 10–5)

    Article  PubMed  Google Scholar 

  8. Schembre DB, Huang JL, Lin OS et al (2008) Treatment of Barrett’s esophagus with early neoplasia: a comparison of endoscopic therapy and esophagectomy. Gastrointest Endosc 67(4):595–601

    Article  PubMed  Google Scholar 

  9. Wu J, Pan YM, Wang TT et al (2014) Endotherapy versus surgery for early neoplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc 79(2):233e2-41e2

    Article  Google Scholar 

  10. Zehetner J, DeMeester SR, Hagen JA et al (2011) Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma. J Thorac Cardiovasc Surg 141(1):39–47

    Article  PubMed  Google Scholar 

  11. Crew KD, Neugut AI (2004) Epidemiology of upper gastrointestinal malignancies. Semin Oncol 31(4):450–464

    Article  PubMed  Google Scholar 

  12. Wang KK, Sampliner RE (2008) Practice parameters committee of the American college of G. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 103(3):788–797

    Article  PubMed  Google Scholar 

  13. Schembre DB (2009) Endotherapy for Barrett’s esophagus with high-grade dysplasia and intramucosal carcinoma. J Gastrointest Surg 13(7):1172–1178

    Article  PubMed  Google Scholar 

  14. Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 17(7):1721–1724

    Article  PubMed  Google Scholar 

  15. Takubo K, Aida J, Sawabe M et al (2007) Early squamous cell carcinoma of the oesophagus: the Japanese viewpoint. Histopathology 51(6):733–742

    Article  CAS  PubMed  Google Scholar 

  16. National Comprehensive Cancer Network (2015) Esophageal cancer and esopagogastric junction cancers (Version 3.2015). https://www.nccn.org/professionals/physician_gls/PDF/esophageal.pdf. Accessed 10 Sept 2015

  17. Ishihara R, Iishi H, Uedo N et al (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68(6):1066–1072

    Article  PubMed  Google Scholar 

  18. Oliveira JF, Moura EG, Bernardo WM et al (2016) Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis. Surg Endosc 30(7):2779–2791

    Article  CAS  PubMed  Google Scholar 

  19. Dhungel B, Diggs BS, Hunter JG et al (2010) Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS–NSQIP), 2005-2008. J Gastrointest Surg 14(10):1492–1501

    Article  PubMed  Google Scholar 

  20. Jamieson GG, Lamb PJ, Thompson SK (2009) The role of lymphadenectomy in esophageal cancer. Ann Surg 250(2):206–209

    Article  PubMed  Google Scholar 

  21. Lagergren J, Mattsson F, Zylstra J et al (2016) Extent of lymphadenectomy and prognosis after esophageal cancer surgery. JAMA Surg 151(1):32–39

    Article  PubMed  Google Scholar 

  22. Solomon N, Zhuge Y, Cheung M et al (2010) The roles of neoadjuvant radiotherapy and lymphadenectomy in the treatment of esophageal adenocarcinoma. Ann Surg Oncol 17(3):791–803

    Article  PubMed  Google Scholar 

  23. Biere SS, Cuesta MA, van der Peet DL (2009) Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Minerva Chir 64(2):121–133

    CAS  PubMed  Google Scholar 

  24. Perry KA, Enestvedt CK, Pham T et al (2009) Comparison of laparoscopic inversion esophagectomy and open transhiatal esophagectomy for high-grade dysplasia and stage I esophageal adenocarcinoma. Arch Surg 144(7):679–684

    Article  PubMed  Google Scholar 

  25. Pham TH, Perry KA, Dolan JP et al (2010) Comparison of perioperative outcomes after combined thoracoscopic–laparoscopic esophagectomy and open Ivor–Lewis esophagectomy. Am J Surg 199(5):594–598

    Article  PubMed  Google Scholar 

  26. Treitl D, Hurtado M, Ben-David K (2016) Minimally invasive esophagectomy: a new era of surgical resection. J Laparoendosc Adv Surg Tech A 26(4):276–280

    Article  PubMed  Google Scholar 

  27. Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349(22):2117–2127

    Article  CAS  PubMed  Google Scholar 

  28. Rodgers M, Jobe BA, O’Rourke RW et al (2007) Case volume as a predictor of inpatient mortality after esophagectomy. Arch Surg 142(9):829–839

    Article  PubMed  Google Scholar 

  29. Gockel I, Sgourakis G, Lyros O et al (2011) Risk of lymph node metastasis in submucosal esophageal cancer: a review of surgically resected patients. Expert Rev Gastroenterol Hepatol 5(3):371–384

    Article  PubMed  Google Scholar 

  30. Luna RA, Gilbert E, Hunter JG (2012) High-grade dysplasia and intramucosal adenocarcinoma in Barrett’s esophagus: the role of esophagectomy in the era of endoscopic eradication therapy. Curr Opin Gastroenterol 28(4):362–369

    Article  PubMed  Google Scholar 

  31. Sgourakis G, Gockel I, Lang H (2013) Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol 19(9):1424–1437

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chennat J, Konda VJ, Ross AS et al (2009) Complete Barrett’s eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma—an American single-center experience. Am J Gastroenterol 104(11):2684–2692

    Article  PubMed  Google Scholar 

  33. Huntington JT, Walker JP, Meara MP et al (2015) Endoscopic mucosal resection for staging and treatment of early esophageal carcinoma: a single institution experience. Surg Endosc 29(8):2121–2125

    Article  PubMed  Google Scholar 

  34. Pouw RE, Seewald S, Gondrie JJ et al (2010) Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 59(9):1169–1177

    Article  PubMed  Google Scholar 

  35. Moore M, Afaneh C, Benhuri D et al (2016) Gastroesophageal reflux disease: a review of surgical decision making. World J Gastrointest Surg 8(1):77–83

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kroep S, Lansdorp-Vogelaar I, Rubenstein JH et al (2016) An accurate cancer incidence in Barrett’s esophagus: a best estimate using published data and modeling. World J Gastrointest Surg 149(3):577e4-85e4 (quiz e14-5)

    Google Scholar 

  37. Altorki NK, Zhou XK, Stiles B et al (2008) Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg 248(2):221–226

    Article  PubMed  Google Scholar 

  38. Ancona E, Rampado S, Cassaro M et al (2008) Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol 15(11):3278–3288

    Article  PubMed  Google Scholar 

  39. Barbour AP, Jones M, Brown I et al (2010) Risk stratification for early esophageal adenocarcinoma: analysis of lymphatic spread and prognostic factors. Ann Surg Oncol 17(9):2494–2502

    Article  PubMed  Google Scholar 

  40. Cen P, Hofstetter WL, Correa AM et al (2008) Lymphovascular invasion as a tool to further subclassify T1b esophageal adenocarcinoma. Cancer 112(5):1020–1027

    Article  PubMed  Google Scholar 

  41. Holscher AH, Bollschweiler E, Schroder W et al (2011) Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg 254(5):802–807 (discussion 07–8)

    Article  PubMed  Google Scholar 

  42. Leers JM, DeMeester SR, Oezcelik A et al (2011) The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg 253(2):271–278

    Article  PubMed  Google Scholar 

  43. Liu L, Hofstetter WL, Rashid A et al (2005) Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma. Am J Surg Pathol 29(8):1079–1085

    PubMed  Google Scholar 

  44. Sepesi B, Watson TJ, Zhou D et al (2010) Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg 210(4):418–427

    Article  PubMed  Google Scholar 

  45. Shimada H, Nabeya Y, Matsubara H et al (2006) Prediction of lymph node status in patients with superficial esophageal carcinoma: analysis of 160 surgically resected cancers. Am J Surg 191(2):250–254

    Article  PubMed  Google Scholar 

  46. Westerterp M, Koppert LB, Buskens CJ et al (2005) Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 446(5):497–504

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, 3181 Sam Jackson Park Rd., Portland, OR, 97239, USA

    Patrick J. McLaren & James P. Dolan

Authors
  1. Patrick J. McLaren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James P. Dolan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James P. Dolan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McLaren, P.J., Dolan, J.P. Surgical Treatment of High-Grade Dysplasia and Early Esophageal Cancer. World J Surg 41, 1712–1718 (2017). https://doi.org/10.1007/s00268-017-3958-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-3958-y

Keywords

Search

Navigation