Richard F Heitmiller1. 1. Department of Surgery, Union Memorial Hospital, 3333 N. Calvert Street, Baltimore, MD 21218, USA. richard.heitmiller@medstar.net
Abstract
OBJECTIVES: We review the significance of Barrett mucosa with high-grade dysplasia, management options, rationale for prophylactic esophagectomy, and results of surgical treatment. PATIENTS AND METHODS: The surgical results of prophylactic esophagectomy are presented from two previous studies, involving 60 patients over 1982-2001 at a single institution. These results are compared with nonsurgical treatment options. RESULTS: The transhiatal esophagectomy technique was the most commonly used surgical approach (81.7% of patients). Operative mortality was 1.7%. The incidence of occult adenocarcinoma for 1982-1994 and 1994-2001 was 43% and 16.7%, respectively. The overall incidence of occult adenocarcinoma for the entire study period was 30%. CONCLUSIONS: Prophylactic esophagectomy for patients with Barrett esophagus and high-grade dysplasia, performed at a center of high volume and experience, can be accomplished with low mortality and excellent long-term survival. Incidence of occult adenocarcinoma is decreasing, but still 16.7-30%.
OBJECTIVES: We review the significance of Barrett mucosa with high-grade dysplasia, management options, rationale for prophylactic esophagectomy, and results of surgical treatment. PATIENTS AND METHODS: The surgical results of prophylactic esophagectomy are presented from two previous studies, involving 60 patients over 1982-2001 at a single institution. These results are compared with nonsurgical treatment options. RESULTS: The transhiatal esophagectomy technique was the most commonly used surgical approach (81.7% of patients). Operative mortality was 1.7%. The incidence of occult adenocarcinoma for 1982-1994 and 1994-2001 was 43% and 16.7%, respectively. The overall incidence of occult adenocarcinoma for the entire study period was 30%. CONCLUSIONS: Prophylactic esophagectomy for patients with Barrett esophagus and high-grade dysplasia, performed at a center of high volume and experience, can be accomplished with low mortality and excellent long-term survival. Incidence of occult adenocarcinoma is decreasing, but still 16.7-30%.
Authors: Ganapathy A Prasad; Kenneth K Wang; Navtej S Buttar; Louis-Michel Wongkeesong; Kausilia K Krishnadath; Francis C Nichols; Lori S Lutzke; Lynn S Borkenhagen Journal: Gastroenterology Date: 2007-02-07 Impact factor: 22.682
Authors: Stuart J Spechler; Prateek Sharma; Rhonda F Souza; John M Inadomi; Nicholas J Shaheen Journal: Gastroenterology Date: 2011-03 Impact factor: 22.682
Authors: Rohit R Sharma; Mark J London; Laura L Magenta; Mitchell C Posner; Kevin K Roggin Journal: J Gastrointest Surg Date: 2009-06-10 Impact factor: 3.452
Authors: Gary D Mackenzie; Neil F Jamieson; Marco R Novelli; C Alexander Mosse; Benjamin R Clark; Sally M Thorpe; Stephen G Bown; Laurence B Lovat Journal: Lasers Med Sci Date: 2007-07-03 Impact factor: 3.161