Barrett's esophagus with high grade dysplasia: Surgical results and long-term outcome - An update

Elaine E. Tseng, T. T. Wu, Charles J. Yeo, Richard F. Heitmiller, Sanjay Nandurkar, Dmitry Oleynikov, Claude Deschamps, Thomas R. DeMeester, Fernando Quijano-Orvananos, Jeffrey H. Peters

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

We updated our surgical results and long-term outcome for prophylactic esophagectomy in patients with Barrett's esophagus and high-grade dysplasia (HGD) and determined the incidence of occult adenocarcinoma. Sixty consecutive patients with HGD who underwent esophagectomy had pre- and postoperative pathology examined at our institution from 1982 to 2001. We reviewed medical records to determine patient characteristics, surgical approach, operative morbidity and mortality, pathology, and length of stay. Patients and/or referring physicians were contacted to determine long-term outcome. Fifty-three men (88%) and 7 women (12%) were followed up for a median of 4.6 years. Transhiatal esophagectomy was performed in the majority of patients (82%). There was one operative death (1.7%) and 15 complications (29%). Median length of stay was 9 days. In 18 patients (30%), invasive adenocarcinoma was detected in the resected specimen. When examined by time periods, 43% (13/30) of patients were diagnosed with occult cancer from 1982-1994, whereas 17% (5/30) harbored occult malignancy from 1994-2001. All patients with adenocarcinoma in the recent interval had stage I disease, as opposed to only 61.5% of patients from the earlier study. Operative mortality declined from 3.3% to 0% over the two intervals as did mean length of stay from 14 days to 10 days. Five-year survival was excellent at 88%. Age and amount of preoperative weight loss were preoperative predictors of survival, whereas major postoperative complications and stage were postoperative predictors of outcome. Barrett's esophagus with high-grade dysplasia continues to be an indication for prophylactic esophagectomy. Overall prevalence of occult adenocarcinoma remains high. We have demonstrated a declining incidence of occult cancer and treatment of earlier stage adenocarcinoma when found in this population of patients treated with esophagectomy.

Original languageEnglish (US)
Pages (from-to)164-171
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume7
Issue number2
DOIs
StatePublished - Feb 2003

Keywords

  • Barrett's esophagus
  • Dysplasia

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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