[Endoluminal therapy of neoplastic changes in the gastrointestinal tract: Barrett esophagus--from the viewpoint of the surgeon].
The need for radical subtotal esophagectomy and extensive lymphadenectomy in patients with early Barrett cancer, i.e. T1 tumors, is increasingly questioned. Based on the principles of surgical oncology, the precancerous nature of Barrett esophagus, and the high rate of lymph node metastases in patients with T1b tumors, the minimal extent of the procedure for early Barrett cancer must include the entire segment of the distal esophagus covered by intestinal metaplasia and a regional lymphadenectomy. In adequately selected patients this can be achieved by a limited surgical procedure with transhiatal resection of the distal esophagus and jejunum interposition, but not by endoscopic mucosal ablation or endoscopic mucosa resection. The high recurrence rates after endoscopic interventions does not support the use of these techniques in operable patients.
Stein
H J
HJ
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 München.
Feith
M
M
Siewert
J R
JR
D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011379:Prognosis