[Surgical treatment of early adenocarcinoma arising in Barrett's oesophagus].
Endoscopy with biopsy, endoscopic ultrasonography and computed tomography (CT) are prerequisites for an exact preoperative staging of patients with oesophageal cancer. Diagnosing an early adenocarcinoma limited to the mucosa (pT1m), the risk of lymph node metastase is nearly zero. Therefore, consideration could be given to ablate endoscopically the metaplastic mucosa including the pT1m-area. On the other hand, an adenocarcinoma that is invading into the submucosa (pTlsm) has an 18 to 50% likelihood of associated lymphnode metastases. In these patients with a highly curable form of oesophageal cancer only oesophageal resection with systematic abdominal and mediastinal lymph node dissection represents the standard of care. This seems to be also true for more advanced tumours without or with neoadjuvant chemoradiation. Because of substantial complications and long-term side effects the need for extensive resection in patients with early tumour stage (pT1) or down staged 'early' carcinoma (yT1) is questionable. Therefore, a limited resection of distal oesophagus and proximal stomach with two-field lymphadenectomy and jejunal interposition is an attractive alternative in early Barrett's carcinoma providing a low morbidity and mortality and resulting in a more than 90% chance of cure, perhaps in successfully down staged yT1-patients as well. Therefore, the extent of oesophageal resection should be tailored to the patient and the known extent of tumour disease. Although, there is no clear evidence at present that RCTx prolongs survival in patients with potentially resectable oesophageal cancer, preoperative treatment appears to increase the chance for a curative resection. Generally, in case of a T4-tumour or distant metastasis a surgical treatment is not indicated.
Thon
K P
KP
Abteilung für Allgemein-, Viszeral- und Unfallchirurgie, Robert-Bosch-Krankenhaus, Stuttgart. klaus-peter.thon@rbk.de
D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D001471:Barrett Esophagus / Q000150:complications*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome