The group assessed the extent of disease in patients with pT1 esophageal
adenocarcinoma, and evaluated the feasibility and outcomes of a limited
71 patients with pT1 adenocarcinoma of the distal esophagus were
included in the study. These underwent transmediastinal or
transthoracic esophagectomy with two-field lymphadenectomy.
24 patients with uT1N0 tumors underwent a limited resection of the
distal esophagus and esophagogastric junction, with regional
lymphadenectomy, and reconstruction by interposition of an
isoperistaltic pedicled jejunal segment.
The two groups were compared for extent and multicentricity of the
primary tumor. In addition, associated high-grade dysplasia, pattern of
lymph node metastases, complications, deaths, and outcome of surgical
treatment were assessed.
" Quality of life after limited resection the same as healthy controls."Dr Hubert Stein.
The study, as reported in December's Annals of Surgery, revealed that
multicentric tumor growth, or associated high-grade dysplasia, was
observed in 60.6 per cent of the resection specimens.
Complete resection of the tumor and the entire segment with intestinal
metaplasia was achieved in all patients, irrespective of the surgical
Patients undergoing limited resection had fewer complications.
Lymph node metastases or micrometastases were present in none of the 38 patients with tumors limited to the mucosa (pT1a) versus 10 of the 56
patients with tumors invading the submucosa (pT1b). Distant lymph node
metastases occurred only in patients with more than three positive
regional lymph nodes. Lymph node metastases were prognostic, but the
pT1a/pT1b category and the surgical approach were not.
The mean Gastrointestinal Quality of Life Index after limited resection
did not differ from that of healthy controls: 20 of the 24 patients were
Dr Hubert Stein, a member of the Munich-based team, reported, "In
patients with early adenocarcinoma in the distal esophagus, resection of
the distal esophagus and esophagogastric junction, with regional
lymphadenectomy and jejunal interposition, is an attractive limited
surgical alternative to radical esophagectomy."