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 23 April 2018

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News

Limited resection for early adenocarcinoma in Barrett's esophagus

A team from Munich, Germany, reports a limited surgical alternative to esophagectomy in patients with early adenocarcinoma in the distal esophagus.

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The group assessed the extent of disease in patients with pT1 esophageal adenocarcinoma, and evaluated the feasibility and outcomes of a limited surgical approach.

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 approach.

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 completely asymptomatic.

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."

Ann Surg 2000; 232: 733-742
27 November 2000

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