Oesophagectomy for early adenocarcinoma and dysplasia arising in Barrett's oesophagus.
BACKGROUND
Oesophagectomy for high-grade dysplasia is controversial.


METHODS
A prospective study was carried out on all patients who presented between 1993 and 2001 with dysplasia or early adeno-carcinoma who were considered fit for surgery. Details of endoscopic biopsies, appearance, surveillance, operative pathology and outcome were recorded.


RESULTS
Of 18 patients, one had low-grade dysplasia, six had high-grade dysplasia and 11 had early adenocarcinoma. No patient had their biopsy diagnosis down-staged following final pathology, but two patients with high-grade dysplasia on biopsy were upstaged to adenocarcinoma. Our only death from disease occurred in a 39-year-old man who had undergone yearly surveillance for 86 months until adenocarcinoma was confirmed. There was no operative mortality.


CONCLUSIONS
Oesophagectomy for early adenocarcinoma and dysplasia in Barrett's oesophagus can be done with acceptable rates of mortality and morbidity. Surveillance until adenocarcinoma is confirmed does not guarantee curable disease.
Thomson
Benjamin N J
BN
Upper Gastrointestinal Surgery, St Vincent's Hospital, Victoria, Australia. ben@meaghan.fsnet.co.uk
Cade
Richard J
RJ
D000230:Adenocarcinoma / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors