Journal article
Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma
The Journal of thoracic and cardiovascular surgery, v 141(1), pp 39-47
01 Jan 2011
PMID: 21055772
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Esophagectomy has been the traditional therapy for high-grade dysplasia and intramucosal adenocarcinoma. New endoscopic approaches allow treatment of these lesions with esophageal preservation. The aim of this study was to compare the outcome of endoscopic therapy with esophagectomy for high-grade dysplasia and intramucosal cancer.
Methods: A retrospective review was performed of all patients treated for high-grade dysplasia or intramucosal adenocarcinoma from 2001 to April 2010.
Results: Endoscopic therapy was performed in 40 patients (high-grade dysplasia 22, intramucosal cancer 18) and esophagectomy in 61 patients (high-grade dysplasia 13, intramucosal cancer 48). Endotherapy consisted of 102 endoscopic resections and 79 mucosal ablations (median 3 interventions per patient). In the endotherapy group, intramucosal cancer was completely resected in all patients. At last assessment, 10 patients have been converted to intestinal metaplasia without dysplasia and 21 to no residual intestinal metaplasia. Five patients have follow-up biopsy procedures pending after recent ablation, and esophagectomy was performed in 3 patients for failed endotherapy. A laparoscopic Nissen fundoplication has been performed in 8 patients after eradication of intestinal metaplasia. Esophagectomy resected the mucosal disease with negative margins in all patients. Compared with esophagectomy, endotherapy was associated with significantly lower morbidity (39% vs 0; P < .0001) and similar survival (94% at 3 years in both groups; median follow-up 34 months after esophagectomy vs 17 months after endotherapy; P = .0026).
Conclusions: Endoscopic therapy for high-grade dysplasia or intramucosal cancer has lower morbidity than an esophagectomy and similar survival during short-term follow-up, but required multiple procedures in most patients. Both therapies are appropriate options, but preservation of the esophagus allows the option of a fundoplication for reflux control, perhaps further improving long-term quality of life. (J Thorac Cardiovasc Surg 2011;141:39-47)
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Details
- Title
- Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma
- Creators
- Joerg Zehetner - College Station Medical CenterSteven R. DeMeester - University of Southern CaliforniaJeffrey A. Hagen - University of Southern CaliforniaShahin Ayazi - University of Southern CaliforniaFlorian Augustin - University of Southern CaliforniaJohn C. Lipham - University of Southern CaliforniaTom R. DeMeester - University of Southern California
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 141(1), pp 39-47
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000285407500013
- Scopus ID
- 2-s2.0-78650263360
- Other Identifier
- 991022048376804721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery