Prophylactic esophagectomy in Barrett esophagus with high-grade dysplasia.
OBJECTIVE
We review the significance of Barrett mucosa with high-grade dysplasia, management options, rationale for prophylactic esophagectomy, and results of surgical treatment.


METHODS
The surgical results of prophylactic esophagectomy are presented from two previous studies, involving 60 patients over 1982-2001 at a single institution. These results are compared with nonsurgical treatment options.


RESULTS
The transhiatal esophagectomy technique was the most commonly used surgical approach (81.7% of patients). Operative mortality was 1.7%. The incidence of occult adenocarcinoma for 1982-1994 and 1994-2001 was 43% and 16.7%, respectively. The overall incidence of occult adenocarcinoma for the entire study period was 30%.


CONCLUSIONS
Prophylactic esophagectomy for patients with Barrett esophagus and high-grade dysplasia, performed at a center of high volume and experience, can be accomplished with low mortality and excellent long-term survival. Incidence of occult adenocarcinoma is decreasing, but still 16.7-30%.
Heitmiller
Richard F
RF
Department of Surgery, Union Memorial Hospital, 3333 N. Calvert Street, Baltimore, MD 21218, USA. richard.heitmiller@medstar.net
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D001471:Barrett Esophagus / Q000473:pathology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology*; D016629:Esophagectomy / Q000379:methods; D006801:Humans; D011230:Precancerous Conditions