Esophagectomy for the Treatment of Barrett’s Esophagus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Tong , ZOU Liangjian.

1. Department of　Cardiothoracic Surgery， Changhai Hospital， Second Military Medical University， Shanghai 200433， P. R. China;;
2. Department of Cardiothoracic Surgery， PLA 401 Hospital， Qingdao 266071， P. R. China;

Corresponding author：

Keywords：

Barrett’s esophagus; High-grade dysplasia; Esophageal adenocarcinoma; Esophagectomy; Lymph node dissection

DOI：

10.7507/1007-4848.20130062

Video：

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Abstract Full text Figures/Tables Video References Cited by

Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.

Citation： XU Tong,ZOU Liangjian.. Esophagectomy for the Treatment of Barrett’s Esophagus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 214-217. doi: 10.7507/1007-4848.20130062 Copy

1.	Wang KK. Samp liner RE. Updated guidelines 2008 for the diagnosis，　surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol， 2008， 103 （3）：788-797.
2.	Fernando HC， Murthy SC， Hofstetter W， et al. The Society of　thoracic surgeons practice guideline series：guidelines for the management of barrett’s esophagus with high-grade dysplasia. Ann Thorac Surg， 2009， 87 （6）：1993-2002.
3.	Rastogi A， Puli S， El-Serag HB， et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia：a meta-analysis. Gastrointest Endosc， 2008， 67 （3）：394-398.
4.	Corley DA， Levin TR， Habel LA. Surveillance and survival in Barrett’s　adenocarcinomas：a population-based study. Gastroenterology， 2002， 122 （3）：633-640.
5.	Van SJ， van Lanschot JJ， ten Kate FJ， et al. Pathology of early　invasive adenocarcinoma of the esophagus or esophagogastric junction：implications for therapeutic decision-making. Cancer， 2000， 88 （11）：2429-2437.
6.	Abraham SC， Krasinskas AM， Correa AM， et al. Duplication of the muscularis mucosae in Barrett esophagus：an underrecognized feature and its implication for staging of adenocarcinoma. Am J Surg Pathol， 2007， 31 （11）：1719-1725.
7.	Nijhawan PK， Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc， 2000， 52 （3）：328-332.
8.	Shaheen NJ， Inadomi JM， Overholt BF， et al. What is the best management strategy for high grade dysplasia in Barrett’s oesophagus ? A cost effectiveness analysis. Gut， 2004， 53 （12）：1736-1744.
9.	Wani S， Puli SR， Shaheen NJ， et al. Esophageal adenocarcinoma in Barrett’s esophagus after endoscopic ablative therapy：a meta-analysis and systematic review. Am J Gastroenterol， 2009， 104 （2）：502-513.
10.	Hagen JA， Demeester SR， Peters JH， et al. Curative resection for esophageal adenocarcinoma：analysis of 100 en bloc esophagectomies. Ann Surg， 2001， 234 （4）：520-530.
11.	Oh DS， Hagen JA， Chandrasoma PT， et al. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Am Coll Surg， 2006， 203 （2）：152-161.
12.	Williams VA， Watson TJ， Herbella FA， et al. Esophagectomy for high grade dysplasia is safe， curative， and results in good alimentary outcome. J Gastrointest Surg， 2007， 11 （12）：1589-1597.
13.	Nguyen NT， Schauer P， Luketich JD. Minimally invasive esophag-ectomy for Barrett’s esophagus with high-grade dysplasia.Surgery， 2000， 127 （3）：284-290.
14.	Nigro JJ， Hagen JA， Demeester TR， et al. Occult esophageal adeno-carcinoma：extent of disease and implications for effective therapy. Ann Surg， 1999， 230 （3）：433-438.
15.	Peyre CG， Demeester SR， Rizzetto C， et al. Vagal-sparing esopha-gectomy：the ideal operation for intramucosal adenocarcinoma and barrett with high-grade dysplasia. Ann Surg， 2007， 246 （4）：665-671.
16.	Stein HJ， Feith M， Mueller J， et al. Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg， 2000， 232 （6）：733-742.
17.	Ell C， May A， Gossner L， et al. Endoscopic mucosal resection of early Cancer and high-grade dysplasia in Barrett’s esophagus.Gastroenterology， 2000， 118 （4）：670-677.
18.	Pouw RE， Bergman JJ. Endoscopic resection of early oesophageal and gastric neoplasia. Best Pract Res Clin Gastroenterol， 2008， 22 （5）：929-943.
19.	Pech O， Günter E， Ell C. Endosonography of high-grade intra-epithelial neoplasia/early cancer. Best Pract Res Clin Gastroenterol， 2009， 23 （5）：639-647.
20.	Manner H， May A， Pech O， et al. Early barrett’s carcinoma with "low-risk" submucosal invasion：long-term results of endoscopic resection with a curative intent. Am J Gastroenterol， 2008， 103 （10）：2589-2597.
21.	Luketich JD， Alvelo-Rivera M， Buenaventura PO， et al. Minimally invasive esophagectomy：outcomes in 222 patients. Ann Surg， 2003， 238 （4）：486-494.
22.	Recommandations de la Société francaise de chirurgie digestive et de l’Association de chirurgie hépatobiliaire et de transplantationhépatique. Critères de qualité en chirurgie carcinologique digestive. J Chir， 2008， 145： 1151.
23.	Keighley MR， Moore J， Lee JR， et al. Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma. Br J Surg， 1981， 68 （2）：73-74.
24.	Mariette C， Castel B， Balon JM， et al. Extent of oesophageal resection for adenocarcinoma of the oesophagogastric junction. Eur J Surg Oncol， 2003， 29 （7）：588-593.
25.	Siewert JR， Stein HJ. Carcinoma of the cardia：carcinoma of the gastroesophageal junction-classification， pathology and extent ofresection. Dis Esophagus， 1996， 9：173-182.
26.	Altorki NK， Zhou XK， Stiles B， et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg， 2008， 248 （2）：221-226.
27.	Altorki N， Kent M， Ferrara C， et al. Three-field lymph node dissectionfor squamous cell and adenocarcinoma of the esophagus. Ann Surg， 2002， 236 （2）：177-183.
28.	Lerut T， Nafteux P， Moons J， et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections：impact on staging， disease-free survival， and outcome：a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg， 2004， 240 （6）：962-972.
29.	Nishimaki T， Suzuki T， Kanda T， et al. Extended radical esopha-gectomy for superficially invasive carcinoma of the esophagus. Surgery，1999， 125 （2）：142-147.
30.	Hulscher JB， Van SJ， Gj O， et al. Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia. Br J Surg， 2001， 88：715-719.
31.	Mariette C， Piessen G， Vons C. La chirurgie ganglionnaire dans les cancers de l’oesophage et de l. estomac. J Chir （Paris）， 2008， 145 （12）：S21.
32.	Orringer MB， Marshall B， Iannettoni MD. Transhiatal esophagectomy：clinical experience and refinements. Ann Surg， 1999， 230 （3）：392-400;discussion400.
33.	Hulscher JB， van Sandick JW， de Boer AG， et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med， 2002， 347 （21）：1662-1669.
34.	Smithers BM， Gotley DC， Martin I， et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg， 2007， 245 （2）：232-240.
35.	Gebski V， Burmeister B， Smithers BM， et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma：a meta-analysis. Lancet Oncol， 2007， 8 （3）：226-234.
36.	Medical Research Council Oesophageal Cancer Working party. Surgical resection with or without preoperative chemotherapy inoesophageal cancer：a randomised controlled trial.Lancet，2002，359 （9319）：1727-1733．.
37.	O’Riordan JM， Tucker ON， Byrne PJ， et al. Factors influencing the development of Barrett’s epithelium in the esophageal remnant postesophagectomy. Am J Gastroenterol，2004，99 （2）：205-211．.
38.	Lerut T， De Leyn P， Coosemans W， et al. Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg， 1992， 216 （5）：583-590.
39.	Omloo JM， Lagarde SM， Hulscher JB， et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus：five-year survival of a randomized clinical trial. Ann Surg， 2007， 246 （6）：992-1000.
40.	Lagarde SM， Reitsma JB， Ten Kate FJ， et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg， 2008， 248 （6）：1006-1013.

1. 　Wang KK. Samp liner RE. Updated guidelines 2008 for the diagnosis，　surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol， 2008， 103 （3）：788-797.
2. 　Fernando HC， Murthy SC， Hofstetter W， et al. The Society of　thoracic surgeons practice guideline series：guidelines for the management of barrett’s esophagus with high-grade dysplasia. Ann Thorac Surg， 2009， 87 （6）：1993-2002.
3. 　Rastogi A， Puli S， El-Serag HB， et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia：a meta-analysis. Gastrointest Endosc， 2008， 67 （3）：394-398.
4. 　Corley DA， Levin TR， Habel LA. Surveillance and survival in Barrett’s　adenocarcinomas：a population-based study. Gastroenterology， 2002， 122 （3）：633-640.
5. 　Van SJ， van Lanschot JJ， ten Kate FJ， et al. Pathology of early　invasive adenocarcinoma of the esophagus or esophagogastric junction：implications for therapeutic decision-making. Cancer， 2000， 88 （11）：2429-2437.
6. 　Abraham SC， Krasinskas AM， Correa AM， et al. Duplication of the muscularis mucosae in Barrett esophagus：an underrecognized feature and its implication for staging of adenocarcinoma. Am J Surg Pathol， 2007， 31 （11）：1719-1725.
7. 　Nijhawan PK， Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc， 2000， 52 （3）：328-332.
8. 　Shaheen NJ， Inadomi JM， Overholt BF， et al. What is the best management strategy for high grade dysplasia in Barrett’s oesophagus ? A cost effectiveness analysis. Gut， 2004， 53 （12）：1736-1744.
9. 　Wani S， Puli SR， Shaheen NJ， et al. Esophageal adenocarcinoma in Barrett’s esophagus after endoscopic ablative therapy：a meta-analysis and systematic review. Am J Gastroenterol， 2009， 104 （2）：502-513.
10. 　Hagen JA， Demeester SR， Peters JH， et al. Curative resection for esophageal adenocarcinoma：analysis of 100 en bloc esophagectomies. Ann Surg， 2001， 234 （4）：520-530.
11. 　Oh DS， Hagen JA， Chandrasoma PT， et al. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Am Coll Surg， 2006， 203 （2）：152-161.
12. 　Williams VA， Watson TJ， Herbella FA， et al. Esophagectomy for high grade dysplasia is safe， curative， and results in good alimentary outcome. J Gastrointest Surg， 2007， 11 （12）：1589-1597.
13. 　Nguyen NT， Schauer P， Luketich JD. Minimally invasive esophag-ectomy for Barrett’s esophagus with high-grade dysplasia.Surgery， 2000， 127 （3）：284-290.
14. 　Nigro JJ， Hagen JA， Demeester TR， et al. Occult esophageal adeno-carcinoma：extent of disease and implications for effective therapy. Ann Surg， 1999， 230 （3）：433-438.
15. 　Peyre CG， Demeester SR， Rizzetto C， et al. Vagal-sparing esopha-gectomy：the ideal operation for intramucosal adenocarcinoma and barrett with high-grade dysplasia. Ann Surg， 2007， 246 （4）：665-671.
16. 　Stein HJ， Feith M， Mueller J， et al. Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg， 2000， 232 （6）：733-742.
17. 　Ell C， May A， Gossner L， et al. Endoscopic mucosal resection of early Cancer and high-grade dysplasia in Barrett’s esophagus.Gastroenterology， 2000， 118 （4）：670-677.
18. 　Pouw RE， Bergman JJ. Endoscopic resection of early oesophageal and gastric neoplasia. Best Pract Res Clin Gastroenterol， 2008， 22 （5）：929-943.
19. 　Pech O， Günter E， Ell C. Endosonography of high-grade intra-epithelial neoplasia/early cancer. Best Pract Res Clin Gastroenterol， 2009， 23 （5）：639-647.
20. 　Manner H， May A， Pech O， et al. Early barrett’s carcinoma with "low-risk" submucosal invasion：long-term results of endoscopic resection with a curative intent. Am J Gastroenterol， 2008， 103 （10）：2589-2597.
21. 　Luketich JD， Alvelo-Rivera M， Buenaventura PO， et al. Minimally invasive esophagectomy：outcomes in 222 patients. Ann Surg， 2003， 238 （4）：486-494.
22. 　Recommandations de la Société francaise de chirurgie digestive et de l’Association de chirurgie hépatobiliaire et de transplantationhépatique. Critères de qualité en chirurgie carcinologique digestive. J Chir， 2008， 145： 1151.
23. 　Keighley MR， Moore J， Lee JR， et al. Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma. Br J Surg， 1981， 68 （2）：73-74.
24. 　Mariette C， Castel B， Balon JM， et al. Extent of oesophageal resection for adenocarcinoma of the oesophagogastric junction. Eur J Surg Oncol， 2003， 29 （7）：588-593.
25. 　Siewert JR， Stein HJ. Carcinoma of the cardia：carcinoma of the gastroesophageal junction-classification， pathology and extent ofresection. Dis Esophagus， 1996， 9：173-182.
26. 　Altorki NK， Zhou XK， Stiles B， et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg， 2008， 248 （2）：221-226.
27. 　Altorki N， Kent M， Ferrara C， et al. Three-field lymph node dissectionfor squamous cell and adenocarcinoma of the esophagus. Ann Surg， 2002， 236 （2）：177-183.
28. 　Lerut T， Nafteux P， Moons J， et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections：impact on staging， disease-free survival， and outcome：a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg， 2004， 240 （6）：962-972.
29. 　Nishimaki T， Suzuki T， Kanda T， et al. Extended radical esopha-gectomy for superficially invasive carcinoma of the esophagus. Surgery，1999， 125 （2）：142-147.
30. 　Hulscher JB， Van SJ， Gj O， et al. Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia. Br J Surg， 2001， 88：715-719.
31. 　Mariette C， Piessen G， Vons C. La chirurgie ganglionnaire dans les cancers de l’oesophage et de l. estomac. J Chir （Paris）， 2008， 145 （12）：S21.
32. 　Orringer MB， Marshall B， Iannettoni MD. Transhiatal esophagectomy：clinical experience and refinements. Ann Surg， 1999， 230 （3）：392-400;discussion400.
33. 　Hulscher JB， van Sandick JW， de Boer AG， et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med， 2002， 347 （21）：1662-1669.
34. 　Smithers BM， Gotley DC， Martin I， et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg， 2007， 245 （2）：232-240.
35. 　Gebski V， Burmeister B， Smithers BM， et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma：a meta-analysis. Lancet Oncol， 2007， 8 （3）：226-234.
36. 　Medical Research Council Oesophageal Cancer Working party. Surgical resection with or without preoperative chemotherapy inoesophageal cancer：a randomised controlled trial.Lancet，2002，359 （9319）：1727-1733．.
37. 　O’Riordan JM， Tucker ON， Byrne PJ， et al. Factors influencing the development of Barrett’s epithelium in the esophageal remnant postesophagectomy. Am J Gastroenterol，2004，99 （2）：205-211．.
38. 　Lerut T， De Leyn P， Coosemans W， et al. Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg， 1992， 216 （5）：583-590.
39. 　Omloo JM， Lagarde SM， Hulscher JB， et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus：five-year survival of a randomized clinical trial. Ann Surg， 2007， 246 （6）：992-1000.
40. 　Lagarde SM， Reitsma JB， Ten Kate FJ， et al. Predicting individual survival after potentially curative esophagectomy for adenocarcinoma of the esophagus or gastroesophageal junction. Ann Surg， 2008， 248 （6）：1006-1013.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Esophagectomy for the Treatment of Barrett’s Esophagus

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