2005 Abstracts: Long-Term Outcome After Esophagectomy for High-Grade Dysplasia or Cancer Found During Surveillance for Barrett's Esophagus
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Long-Term Outcome After Esophagectomy for High-Grade Dysplasia or Cancer Found During Surveillance for Barrett's Esophagus
Lily Chang, Boston University Medical Center, Boston, MA; Brant Oelschlager, Elina Quiroga, Juan D. Parra, Michael Mulligan, Douglas Wood, Carlos Pellegrini, University of Washington Medical Center, Seattle, WA
Background: Endoscopic surveillance of Barrett's esophagus is recommended to detect dysplastic or malignant changes at an early stage. This study analyzes outcomes of a cohort of patients who underwent esophagectomy after progression was detected while on a Barrett's surveillance program.
Methods: Between Feb 1995 and Feb 2003, 39 patients (86 % males, median age 65 years, range 38-84) underwent esophagectomy for esophageal cancer or high-grade dysplasia (HGD) discovered during surveillance for Barrett's esophagus. We contacted 37/39 patients (95%), 2 refused to participate. The remaining 35 patients agreed to an evaluation. Results: Barrett's surveillance: Mean surveillance before operation was 63 months (range 4-228); mean number of endoscopies was 13 (range 3-30). Preoperative diagnosis was HGD in 11 pts (28 %), carcinoma-in-situ in 18 pts (46 %) and invasive adenocarcinoma in 10 pts (26%). Esophagectomy: 33 patients underwent transhiatal esophagectomy while 6 had thoracic and abdominal approaches. There was no mortality. Five patients had complications (diaphragmatic hernia in 2, laryngeal nerve injury, intraabdominal hemorrhage, hemothorax). Final pathologic diagnosis was HGD in 17, carcinoma in situ in 12, invasive cancer in 10. Postoperative Quality of Life: Using SF-36 survey, patients answered questions about quality of life in 7 areas: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE). Results show that our patients have an above average quality of life with respect to national averages shown in parentheses: PF 51.6 (49.3), RP 50.2 (49.3), BP 57.5 (49.5), GH 51.5 (49.8), VT 56.2 (52.1), SF 53 (50.9), RE 54.1 (51.1). Postoperative Symptoms: Incidence(%)/Severity scores (VAS 1-10) are as follows: reflux 61%/2.8; dysphagia 29%/3.7; bloating 46%/2.6; nausea 29%/2.1; diarrhea 57%/2.5. Follow-up: Mean follow-up was 44 months (range 13-89 months). Six patients had died: one esophageal cancer, one tongue cancer, one heart disease, one renal failure, and two unknown. Remaining 84% are alive. 18 patients are free of disease by CT or upper endoscopy. Conclusions: Endoscopic surveillance allows for discovery of malignant lesions from Barrett's at an early, generally curable, stage. Esophagectomy is curative in the great majority and can be accomplished with minimal mortality and excellent quality of life.
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