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The Annals of Thoracic Surgery, Vol 54, 199-204, Copyright © 1992 by The Society of Thoracic Surgeons
M Pera, VF Trastek, HA Carpenter, MS Allen, C Deschamps and PC Pairolero
Between 1982 and 1991, 19 patients (17 men and 2 women) with Barrett's
esophagus, 10 of whom were in a surveillance program, were found to have
high-grade dysplasia without evidence of invasive carcinoma. Median age was
66 years (range, 30 to 79 years). Heartburn was the most common presenting
symptom. Esophagoscopy at the time of high-grade dysplasia diagnosis
demonstrated normal Barrett's mucosa in 10 patients (53%), shallow ulcers
in 3, slight mucosal irregularities in 2, small mucosal nodules in 2,
stricture in 1, and shallow ulcer with stricture in 1. Eighteen patients
underwent esophagectomy. There were no operative deaths. Nine patients
(50%) had invasive carcinoma. Postsurgical stage was stage 0 in 9 patients,
stage I in 6, stage IIA in 2, and stage IIB in 1. Median follow-up was 34
months (range, 2 to 116 months). Recurrent cancer developed in 2 patients.
Overall 5-year survival was 66.7%; 5-year survival for patients with stage
0 disease was 100% and for stage I and II disease, 35.7%. We conclude that
high- grade dysplasia in an indication for esophageal resection because of
the high rate of associated early invasive carcinoma and that resection can
be done safely with the expectation of excellent long-term survival.
Because of these findings, we continue to recommend endoscopic surveillance
in all patients with Barrett's esophagus.
ARTICLES
Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy?
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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