Early adenocarcinoma in Barrett's oesophagus

Abstract

The results of surgical treatment in 41 patients with early adenocarcinoma of the oesophagus were analysed retrospectively. The treatment of choice was transhiatal radical subtotal oesophagectomy (n = 38); in three patients with adenocarcinoma in the mid or upper thoracic portion of the oesophagus, right transthoracic en bloc oesophagectomy was performed. One patient died within 30 days and another within 90 days (4.8 per cent). All tumours were resected completely. Multicentricity of adenocarcinoma in Barrett's oesophagus was detected in six cases and high-grade dysplasia in 28. Some 31 patients had infiltration of the submucosa, whereas in ten, carcinoma was limited to the mucosa. No patient with mucosal adenocarcinoma had lymph node metastases, whereas five of the 31 with submucosal infiltration showed lymph node involvement. The 5-year survival rate of the total group of 41 patients, including postoperative mortality, was 83 per cent. All ten patients with adenocarcinoma limited to the mucosa (pT1a) were alive at 5 years; of 31 with submucosal infiltration (pT1b) 79 per cent survived to 5 years (P not significant). Patients without lymph node metastasis had a 5-year survival rate of 81 per cent, compared with 50 per cent for those in the pN1 category (P not significant). Oesophagectomy for early oesophageal adenocarcinoma is safe and leads to a favourable long-term prognosis.