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Approach to Early Barrett’s Cancer

  • World Progress in Surgery
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Abstract

Because of effective surveillance programs in patients with known Barrett’s esophagus, adenocarcinoma of the distal esophagus is increasingly diagnosed at early stages. With the introduction of limited surgical and endoscopic treatment modalities, the need for radical esophagectomy and extensive lymphadenectomy in such patients has been questioned. When selecting the approach to early Barrett’s cancer, the precancerous nature of the underlying Barrett’s esophagus, the frequent multicentricity of neoplastic alterations within the Barrett mucosa, the inaccuracy of current staging modalities, and the presence of lymph node metastases should be taken into account. Invasiveness and morbidity of the procedures, as well as quality of life aspects, should also be considered. From an oncologic point of view the minimum extent of a resection for early Barrett’s cancer should include a full-thickness removal of the entire segment of the distal esophagus covered by intestinal metaplasia together with a regional lymphadenectomy. In appropriately selected patients this can be achieved by a limited surgical procedure involving transhiatal resection of the distal esophagus, but not by endoscopic mucosal ablation or endoscopic mucosa resection. Our experience with 49 limited surgical resections with regional lymphadenectomy indicates that this procedure is oncologically adequate and safe. Reconstruction with an interposed jejunal loop prevents postoperative gastroesophageal reflux and is associated with good quality of life. In contrast, endoscopic interventions are plagued by a high tumor recurrence rate, probably from persistence of Barrett’s mucosa and gastroesophageal reflux.

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References

  1. SJ Spechler (2002) ArticleTitleBarrett’s esophagus N. Engl. J. Med. 346 836–842 Occurrence Handle10.1056/NEJMcp012118 Occurrence Handle11893796

    Article  PubMed  Google Scholar 

  2. JH Peters GW Clark AP Ireland (1994) ArticleTitleOutcome of adenocarcinoma arising in Barrett’s esophagus in endoscopically surveyed and nonsurveyed patients J. Thorac. Cardiovasc. Surg. 108 813–822 Occurrence Handle1:STN:280:ByqD2MjitFc%3D

    CAS  Google Scholar 

  3. JW Sandick ParticleVan JJ Lanschot Particlevan BW Kuiken et al. (1998) ArticleTitleImpact of endoscopic biopsy surveillance of Barrett’s oesophagus on pathological stage and clinical outcome of Barrett’s carcinoma Gut 43 216–222 Occurrence Handle10189847

    PubMed  Google Scholar 

  4. HJ Stein M Feith J Müller et al. (2000) ArticleTitleLimited resection for early Barrett’s cancer Ann. Surg. 232 733–742 Occurrence Handle1:STN:280:DC%2BD3M%2FltVyntw%3D%3D

    CAS  Google Scholar 

  5. JJ Nigro JA Hagen TR DeMeester et al. (1999) ArticleTitleOccult esophageal adenocarcinoma: extent of disease and implications for effective therapy Ann. Surg. 230 433–438 Occurrence Handle1:STN:280:DyaK1MvitFagsA%3D%3D

    CAS  Google Scholar 

  6. C Ell A May L Gossner et al. (2000) ArticleTitleEndoscopic mucosal resection of early cancer and high grade dysplasia in Barrett’s esophagus Gastroenterology 118 670–677 Occurrence Handle1:STN:280:DC%2BD3c3gtVehsQ%3D%3D Occurrence Handle10734018

    CAS  PubMed  Google Scholar 

  7. L Gossner A May M Stolte et al. (1999) ArticleTitleKTP laser destruction of dysplasia and early cancer in columnar-lined Barrett’s esophagus Gastrointest. Endosc. 49 8–12 Occurrence Handle1:STN:280:DyaK1M%2Fosl2qsw%3D%3D

    CAS  Google Scholar 

  8. L Gossner M Stolte R Sroka et al. (1998) ArticleTitlePhotodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid Gastroenterology 114 448–455 Occurrence Handle1:CAS:528:DyaK1cXhvVyhu7s%3D Occurrence Handle9496934

    CAS  PubMed  Google Scholar 

  9. P Sharma (2002) ArticleTitleEndoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus Gastrointest. Endosc. 55 137–139 Occurrence Handle11789480

    PubMed  Google Scholar 

  10. A May L Gossner O Pech et al. (2002) ArticleTitleIntraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett’s esophagus (SSBE). Curative treatment using local endoscopic treatment techniques Endoscopy 34 604–610 Occurrence Handle10.1055/s-2002-33236 Occurrence Handle1:STN:280:DC%2BD38vhsl2hsw%3D%3D Occurrence Handle12173079

    Article  CAS  PubMed  Google Scholar 

  11. MA Ortner G Dorta AL Blum et al. (2002) ArticleTitleEndoscopic interventions for preneoplastic and neoplastic lesions: mucosectomy, argon plasma coagulation, and photodynamic therapy Dig. Dis. 20 167–172 Occurrence Handle10.1159/000067489 Occurrence Handle12566619

    Article  PubMed  Google Scholar 

  12. AH Ormsby RE Petras WH Henricks et al. (2002) ArticleTitleObserver variation in the diagnosis of superficial oesophageal adenocarcinoma Gut 51 671–676 Occurrence Handle10.1136/gut.51.5.671 Occurrence Handle1:STN:280:DC%2BD38nktlCntw%3D%3D Occurrence Handle12377805

    Article  CAS  PubMed  Google Scholar 

  13. RJ Schlemper RH Riddell Y Kato et al. (2000) ArticleTitleThe Vienna classification of gastrointestinal epithelial neoplasia Gut 47 251–255 Occurrence Handle1:STN:280:DC%2BD3cvgsVWjsA%3D%3D Occurrence Handle10896917

    CAS  PubMed  Google Scholar 

  14. M Werner JF Flejou P Hainaut et al. (2000) Adenocarcinoma of the oesophagus SR Hamilton L Aaltonen (Eds) World Health Organization Classification of Tumours: Pathology and Genetics—Tumours of the Digestive System IARC Press Lyon, France 20–25

    Google Scholar 

  15. TG Schnell SJ Sontag G Chejfec et al. (2001) ArticleTitleLong-term nonsurgical management of Barrett’s esophagus with high grade dysplasia Gastroenterology 120 1607–1619 Occurrence Handle1:STN:280:DC%2BD3M3ps1Ghsw%3D%3D Occurrence Handle11375943

    CAS  PubMed  Google Scholar 

  16. HJ Steinl (1996) ArticleTitleEsophageal cancer: screening and surveillance. Results of a consensus conference Dis. Esoph. 9 3–19

    Google Scholar 

  17. BJ Reid DS Levine G Longton et al. (2000) ArticleTitlePredictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets Am. J. Gastroenterol. 95 1669–1676 Occurrence Handle1:STN:280:DC%2BD3cvgvVWntQ%3D%3D

    CAS  Google Scholar 

  18. JM Collard (2002) ArticleTitleHigh-grade dysplasia in Barrett’s esophagus. The case for esophagectomy Chest Surg. Clin. N. Am. 12 77–92 Occurrence Handle11901935

    PubMed  Google Scholar 

  19. AH Holscher E Bollschweiler PM Schneider et al. (1997) ArticleTitleEarly adenocarcinoma in Barrett’s oesophagus Br. J. Surg. 84 1470–1473 Occurrence Handle1:STN:280:DyaK1c%2FislKrtQ%3D%3D Occurrence Handle9361616

    CAS  PubMed  Google Scholar 

  20. JR Headrick FC Nichols DL Miller et al. (2002) ArticleTitleHigh-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy Ann. Thorac. Surg. 73 1697–1703 Occurrence Handle10.1016/S0003-4975(02)03496-3 Occurrence Handle12078755

    Article  PubMed  Google Scholar 

  21. JD Kirby (1999) ArticleTitleQuality of life after oesophagectomy: the patients’ perspective Dis. Esoph. 12 168–171 Occurrence Handle10.1046/j.1442-2050.1999.00040.x Occurrence Handle1:STN:280:DC%2BD3c%2FpslGhtg%3D%3D

    Article  CAS  Google Scholar 

  22. HC Fernando JD Luketich PO Buenaventura et al. (2002) ArticleTitleOutcomes of minimally invasive esophagectomy (MIE) for high-grade dysplasia of the esophagus Eur. J. Cardiothorac. Surg. 22 1–6 Occurrence Handle1:STN:280:DC%2BD38zlvFClug%3D%3D

    CAS  Google Scholar 

  23. F Banki R Mason SR DeMeester et al. (2002) ArticleTitleVagal-sparing esophagectomy: a more physiologic alternative Ann. Surg. 236 324–336 Occurrence Handle10.1097/00000658-200209000-00009 Occurrence Handle12192319

    Article  PubMed  Google Scholar 

  24. HJ Stein M Feith (2001) Cancer of the esophagus M Gospodarowicz DE Henson RVP Hutter (Eds) Prognostic Factors in Cancer Wiley-Liss New York 237–249

    Google Scholar 

  25. JW Sandick ParticleVan JJ Lanschot Particlevan FJ Kate Particleten et al. (2000) ArticleTitlePathology of early invasive adenocarcinoma of the esophagus or esophagogastric junction: implications for therapeutic decision making Cancer 88 2429–2437 Occurrence Handle10.1002/1097-0142(20000601)88:11<2429::AID-CNCR1>3.0.CO;2-H Occurrence Handle10861416

    Article  PubMed  Google Scholar 

  26. NS Buttar KK Wang TJ Sebo et al. (2001) ArticleTitleExtent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma Gastroenterology 120 1630–1639 Occurrence Handle1:STN:280:DC%2BD3M3ps1GhsQ%3D%3D

    CAS  Google Scholar 

  27. KA Merendino DH Dillard (1955) ArticleTitleThe concept of sphincter substitution by an interposed jejunal segment for anatomic and physiological abnormalities at the esophagogastric junction Ann. Surg. 142 486–506 Occurrence Handle13249345

    PubMed  Google Scholar 

  28. SM Dresner PJ Lamb MK Bennett et al. (2001) ArticleTitleThe pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction Surgery 129 103–109 Occurrence Handle10.1067/msy.2001.110024 Occurrence Handle1:STN:280:DC%2BD3M7ht1Shuw%3D%3D Occurrence Handle11150040

    Article  CAS  PubMed  Google Scholar 

  29. W Schroder SP Monig SE Baldus et al. (2002) ArticleTitleFrequency of nodal metastases to the upper mediastinum in Barrett’s cancer Ann. Surg. Oncol. 9 807–811 Occurrence Handle1:STN:280:DC%2BD38nhslahsw%3D%3D

    CAS  Google Scholar 

  30. K Takeshita N Saito I Saeki et al. (1997) ArticleTitleProximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: surgical techniques and evaluation of postoperative function Surgery 121 278–286 Occurrence Handle1:STN:280:ByiB2cnkt1c%3D

    CAS  Google Scholar 

  31. HA Gaissert DJ Mathisen HC Grillo et al. (1993) ArticleTitleShort-segment intestinal interposition of the distal esophagus J. Thorac. Cardiovasc. Surg. 106 860–866 Occurrence Handle1:STN:280:ByuD2cfhslc%3D

    CAS  Google Scholar 

  32. ZB Gerzic (1997) ArticleTitleModification of the Merendino procedure Dis. Esoph. 10 270–275 Occurrence Handle1:STN:280:DyaK1c7hs1ygsA%3D%3D

    CAS  Google Scholar 

  33. KA Mansour FC Bryan GW Carlson (1997) ArticleTitleBowel interposition for esophageal replacement: twenty-five-year experience Ann. Thorac. Surg. 64 752–756 Occurrence Handle1:STN:280:ByiH2M3mslw%3D

    CAS  Google Scholar 

  34. M Saeki Y Tsuchida T Ogata et al. (1988) ArticleTitleLong-term results of jejunal replacement of the esophagus J. Pediatr. Surg. 23 483–489 Occurrence Handle1:STN:280:BieB2crgtVQ%3D

    CAS  Google Scholar 

  35. EP Eypasch JI Williams S Wood-Dauphinee et al. (1995) ArticleTitleGastrointestinal Quality of Life Index: development, validation and application of a new instrument Br. J. Surg. 82 216–222 Occurrence Handle1:STN:280:ByqB28fnslE%3D

    CAS  Google Scholar 

  36. A May L Gossner O Pech et al. (2002) ArticleTitleLocal endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach Eur. J. Gastroenterol. Hepatol. 14 1085–1091 Occurrence Handle10.1097/00042737-200210000-00009 Occurrence Handle12362099

    Article  PubMed  Google Scholar 

  37. NS Buttar KK Wang LS Lutzke et al. (2001) ArticleTitleCombined endoscopic mucosal resection and photodynamic therapy for esophageal neoplasia within Barrett’s esophagus Gastrointest. Endosc. 54 682–838 Occurrence Handle1:STN:280:DC%2BD3MnotVekuw%3D%3D

    CAS  Google Scholar 

  38. H Akiyama M Tsurumaru Y Ono et al. (1994) ArticleTitleEsophagectomy without thoracotomy with vagal preservation J. Am. Coll. Surg. 178 83–85 Occurrence Handle1:STN:280:ByuB3cjksFM%3D

    CAS  Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik der Technischen Universität München, Klinikum Rechts der Isar, Ismaningerstrasse 22, D-81675, München, Germany

    Hubert J. Stein M.D., Marcus Feith M.D., Burkhard A.H. v. Rahden M.D. & J. Rüdiger Siewert M.D.

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  1. Hubert J. Stein M.D.
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  2. Marcus Feith M.D.
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  3. Burkhard A.H. v. Rahden M.D.
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  4. J. Rüdiger Siewert M.D.
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Correspondence to Hubert J. Stein M.D..

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Stein, H., Feith, M., Rahden, B. et al. Approach to Early Barrett’s Cancer. World J. Surg. 27, 1040–1046 (2003). https://doi.org/10.1007/s00268-003-7059-8

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