Quality of Life After Limited Esophageal Resection in Comparison to Abdomino-Thoracic Resection in Early Barrett's Adenocarcinoma

Abstract

Early Barrett's adenocarcinoma is primarily treated by endoscopic mucosa resection (EMR). In cases of submucosal infiltration, local lymphatic infiltration, venous infiltration or a local R1 situation esophageal resection is the treatment of choice. Limited resection with a jejunual segment as interposition to reconstruct the passage has been introduced to cure short Barrett's adenocarcinoma at the gastroesophageal junction. Conventional esophageal resection using a abdomino-right-thoracic approach is performed in all other cases. Although some clinical studies have shown that the limited resection does not lead to compromises concerning the oncologic situation little is known about quality of life after limited resection compared to the conventional approach. From 07/2000 until 06/2005 62 patients have been treated with early Barrett's adenocarcinoma. In 42 patients a conventional resection was performed whereas 20 patients were treated with a limited resection. One year after operation a questionnaire was used to evaluate quality of life (QoL) using the EORTC QLQ-C30 module and the EORTC OES-18 modules. Mann-Whitney-test wa sused for group comparisons. QoL global health status was similarily reduced in both groups compared to base line and a healthy population. Specific questions like loss of appetite, nausea/vomiting, dysphagia, diarrhoea did not show any significant differences between groups. However, dyspnea and pulmonary complications occured significantly more often in conventionally operated patients. Postoperative weight loss was significantly higher in patients treated with the abdomino-thoracic approach. Moreover, after limited resection patients were taken care of on ICU a significantly shorter period than in the other group and patients were discharged from hospital some days earlier (20,2 vs. 24,4 days). Limited esophageal resection is a technically advanced procedure with low morbidity and mortality. QoL is very similar compared with the conventional approach. However, we have observed significant improvement concerning pulmonary complications and postoperative weight loss. Early Barrett's adenocarcinoma requires a differentiated individual concept for each patient. EMR should be performed in patients with a mucosal infiltration whereas surgical treatment should be considered for all patients with submucosal infiltration or mucosal infiltration including riskfactors (L1, V1, R1). In our opinion limited esophageal resection represents the best treatment for patients with short early Barrett's adenocarcinoma showing submucosal infiltration or mucosal infiltration including riskfactors close to the gastroesophageal junction.