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Molena D, DeMeester SR. Response. Gastrointest Endosc 2021; 93:284-285. [PMID: 33353636 DOI: 10.1016/j.gie.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Daniela Molena
- Associate Professor, Director of Esophageal Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven R DeMeester
- University of Southern California School of Medicine, Los Angeles, California, USA
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Badgery H, Read M, Winter NN, Taylor ACF, Hii MW. The role of esophagectomy in the management of Barrett's esophagus with high-grade dysplasia. Ann N Y Acad Sci 2020; 1481:72-89. [PMID: 32812261 DOI: 10.1111/nyas.14439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 12/19/2022]
Abstract
Barrett's esophagus (BE) with high-grade dysplasia (HGD) has previously been a routine indication for esophagectomy. Recent advances in endoscopic therapy have resulted in a shift away from surgery. Current international guidelines recommend endoscopic therapy for BE with HGD irrespective of recurrence or progression of dysplasia. Current guidelines do not address the ongoing role of esophagectomy as an adjunct in the setting of failed endoscopic therapy. This review examines the role of esophagectomy as an adjunct to endoscopy in the management of patients with BE and HGD, with a specific focus on patients with persistent, progressive, or recurrent disease, disease resistant to endoscopic therapy, in patients with concomitant esophageal pathology, and in those patients in whom lifelong surveillance may not be possible or desired.
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Affiliation(s)
- Henry Badgery
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nicole N Winter
- Department of Upper Gastrointestinal Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew C F Taylor
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
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Schwameis K, Green KM, Worrell SG, Samaan J, Cooper S, Tatishchev S, Oh DS, Hagen JA, DeMeester SR. Outcome with Primary En-bloc Esophagectomy for Submucosal Esophageal Adenocarcinoma. Ann Surg Oncol 2017; 24:3921-3925. [PMID: 28975518 DOI: 10.1245/s10434-017-6091-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intramucosal esophageal adenocarcinoma can be reliably treated endoscopically. Controversy exists about the use of endotherapy versus esophagectomy for submucosal tumors. Increasingly endotherapy is considered for submucosal tumors in part because of the presumed high mortality with esophagectomy and the perceived poor prognosis in patients with nodal disease. This study was designed to assess survival following primary en bloc esophagectomy (EBE) in patients with submucosal esophageal adenocarcinoma (EAC). METHODS This is a retrospective review of all patients who underwent EBE for submucosal EAC between 1998 and 2015. No patient had neoadjuvant therapy. RESULTS There were 32 patients (28M/4F; median age 64 years). The median tumor size was 1.5 cm (0.4-8.0), and the median number of resected nodes was 48 (23-85). There was one perioperative death. Lymph node metastases were present in 7 patients (22%). There was one involved node in four patients and 2, 3, and 31 nodes in one patient each. The one N3 patient received adjuvant therapy. The median follow-up was 87 months. Overall survival at 5 and 10 years was 84 and 70% respectively. Disease-specific survival at 10 years was 90%. Eight patients died, but only three deaths (9%) were related to EAC. Disease-specific survival at 10 years in node-positive patients was 71%. CONCLUSIONS Survival after primary en bloc esophagectomy for submucosal adenocarcinoma was excellent even in node-positive patients. Mortality with esophagectomy was low and far less than the 22% risk of node metastases in patients with submucosal tumor invasion. Esophagectomy should remain the preferred treatment for T1b esophageal adenocarcinoma.
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Affiliation(s)
- Katrin Schwameis
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Kyle M Green
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Stephanie G Worrell
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Jamil Samaan
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Shannon Cooper
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Sergei Tatishchev
- Department of Pathology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Daniel S Oh
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Jeffrey A Hagen
- Department of Thoracic Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Steven R DeMeester
- The Oregon Clinic, Gastrointestinal & Minimally Invasive Surgery, Portland, OR, USA.
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Whiteman DC, Kendall BJ. Barrett's oesophagus: epidemiology, diagnosis and clinical management. Med J Aust 2016; 205:317-24. [DOI: 10.5694/mja16.00796] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/09/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Bradley J Kendall
- QIMR Berghofer Medical Research Institute, Brisbane, QLD
- University of Queensland, Brisbane, QLD
- Princess Alexandra Hospital, Brisbane, QLD
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