Vagal-sparing esophagectomy: the ideal operation for intramucosal adenocarcinoma and barrett with high-grade dysplasia.
OBJECTIVE
Our aim was to compare outcome of vagal-sparing esophagectomy with transhiatal and en bloc esophagectomy in patients with intramucosal adenocarcinoma or high-grade dysplasia.


BACKGROUND
Intramucosal adenocarcinoma and high grade dysplasia have a low likelihood of lymphatic or systemic metastases and esophagectomy is curative in most patients. However, traditional esophagectomy is associated with significant morbidity and altered gastrointestinal function. A vagal-sparing esophagectomy offers the advantages of complete disease removal with the potential for reduced morbidity and a better functional outcome.


METHODS
Retrospective review of outcome in patients with intramucosal adenocarcinoma or high grade dysplasia that had a vagal-sparing (n=49), transhiatal (n=39) or en bloc (n=21) esophagectomy.


RESULTS
The length of hospital stay and the incidence of major complications was significantly reduced with a vagal-sparing esophagectomy compared with a transhiatal or en bloc resection. Further, postvagotomy dumping and diarrhea symptoms were significantly less common, and weight was better maintained postoperatively with a vagal-sparing esophagectomy. Recurrent cancer has developed in only 1 patient.


CONCLUSIONS
Survival with intramucosal adenocarcinoma or Barrett's with high-grade dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or high grade dysplasia.
Peyre
Christian G
CG
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
DeMeester
Steven R
SR
Rizzetto
Christian
C
Bansal
Neeraj
N
Tang
Andrew L
AL
Ayazi
Shahin
S
Leers
Jessica M
JM
Lipham
John C
JC
Hagen
Jeffrey A
JA
DeMeester
Tom R
TR
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery; D001835:Body Weight / Q000502:physiology; D003967:Diarrhea / Q000517:prevention & control; D004377:Dumping Syndrome / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology*