OBJECTIVES: Optimal therapy for Barrett's mucosa is controversial. Photodynamic therapy has recently been introduced as a technique for eradicating Barrett's mucosa with high-grade dysplasia. We sought to determine the incidence of invasive cancer and the outcomes after resection for high-grade dysplasia and to compare these results with published results of photodynamic therapy. METHODS: We performed a retrospective review of patients who underwent esophagectomy for Barrett's esophagus from 1985 to 1996 and completed a metaanalysis of published results of surgery for Barrett's esophagus with high-grade dysplasia. RESULTS: Thirteen men and two women with a mean age of 63 years underwent resection for Barrett's esophagus with high-grade dysplasia. The operation was performed through a transhiatal approach in nine and a transthoracic approach in six patients. There was no operative mortality. The final pathologic study demonstrated dysplasia in four patients, carcinoma-in-situ in three, and invasive carcinoma in eight patients (53%). All patients are alive and none of the patients with invasive cancer has recurrent disease. A metaanalysis of published results of 119 patients undergoing resection demonstrated an operative mortality of 2.6%, an incidence of invasive cancer of 47%, and a 5-year survival in patients with invasive carcinoma of 82%. CONCLUSIONS: A substantial percentage of patients with Barrett's mucosa containing foci of high-grade dysplasia have invasive carcinoma at the time of diagnosis. Resection is accompanied by a low operative risk, achieves an excellent long-term outcome, and should remain the standard therapy for Barrett's esophagus with high-grade dysplasia.
OBJECTIVES: Optimal therapy for Barrett's mucosa is controversial. Photodynamic therapy has recently been introduced as a technique for eradicating Barrett's mucosa with high-grade dysplasia. We sought to determine the incidence of invasive cancer and the outcomes after resection for high-grade dysplasia and to compare these results with published results of photodynamic therapy. METHODS: We performed a retrospective review of patients who underwent esophagectomy for Barrett's esophagus from 1985 to 1996 and completed a metaanalysis of published results of surgery for Barrett's esophagus with high-grade dysplasia. RESULTS: Thirteen men and two women with a mean age of 63 years underwent resection for Barrett's esophagus with high-grade dysplasia. The operation was performed through a transhiatal approach in nine and a transthoracic approach in six patients. There was no operative mortality. The final pathologic study demonstrated dysplasia in four patients, carcinoma-in-situ in three, and invasive carcinoma in eight patients (53%). All patients are alive and none of the patients with invasive cancer has recurrent disease. A metaanalysis of published results of 119 patients undergoing resection demonstrated an operative mortality of 2.6%, an incidence of invasive cancer of 47%, and a 5-year survival in patients with invasive carcinoma of 82%. CONCLUSIONS: A substantial percentage of patients with Barrett's mucosa containing foci of high-grade dysplasia have invasive carcinoma at the time of diagnosis. Resection is accompanied by a low operative risk, achieves an excellent long-term outcome, and should remain the standard therapy for Barrett's esophagus with high-grade dysplasia.
Authors: Daniela Molena; Francisco Schlottmann; Joshua A Boys; Shanda H Blackmon; Karen J Dickinson; Christy M Dunst; Wayne L Hofstetter; Michal J Lada; Brian E Louie; Benedetto Mungo; Thomas J Watson; Steven R DeMeester Journal: J Gastrointest Surg Date: 2016-08-25 Impact factor: 3.452
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