title: Minimally invasive esophagectomy for dysplastic Barrett's esophagus.
abstract: A substantial portion of patients diagnosed preoperatively with high grade dysplasia (HGD) alone will have occult esophageal adenocarcinoma on analysis of the surgical specimen. Therefore, because of an increased risk of disease progression and malignancy, patients with HGD should be referred for esophagectomy promptly when endoscopic therapy has failed. The required extent of lymphadenectomy in this cohort of patients is unknown because of the variable incidence of submucosal cancer observed. Improvements in perioperative care, adoption of a minimally invasive surgical approach, and centralization of esophageal cancer services have substantially reduced the rates of mortality and morbidity associated with esophagectomy in recent years. Minimally invasive esophagectomy should be considered the treatment of choice in patients with dysplastic Barrett's esophagus that is refractory to endoscopic therapy or those at high risk of invasive cancer.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, 10th Floor QEQM Building, South Wharf Road, London, W2 1NY, UK, s.markar@imperial.ac.uk.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: George
authors.initials: G
authors.lastname: Hanna
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D018579:Patient Selection; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life