Resection for Barrett's mucosa with high-grade dysplasia: implications for prophylactic photodynamic therapy.
OBJECTIVE
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.
Ferguson
M K
MK
Department of Surgery, University of Chicago, IL 60637, USA.
Naunheim
K S
KS
D001471:Barrett Esophagus / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D012189:Retrospective Studies