Clinical Biology and Surgical Therapy of Intramucosal Adenocarcinoma of the Esophagus: Influence Statistics

Expert Impact

Concepts for which they have has direct influence: Intramucosal adenocarcinoma , Surgical resection , Gastroesophageal junction , Barretts esophagus , Intramucosal adenocarcinoma esophagus , Sparing esophagectomy , Adenocarcinoma esophagus .

Key People For Intramucosal Adenocarcinoma

Top KOLs in the world
#1
John R Goldblum
situ hybridization intestinal metaplasia barrett esophagus
#2
Gary W Falk
eosinophilic esophagitis barretts esophagus esophageal adenocarcinoma
#3
Christian Ell
endoscopic resection photodynamic therapy small bowel
#4
Kenneth K Wang
barrett esophagus photodynamic therapy esophageal adenocarcinoma
#5
M Stolte Stolte
helicobacter pylori gastric cancer ulcerative colitis
#6
Bergein F Overholt
photodynamic therapy radiofrequency ablation esophageal cancer

Clinical Biology and Surgical Therapy of Intramucosal Adenocarcinoma of the Esophagus

Abstract

. BACKGROUND: Mucosal ablation and endoscopic mucosal resection have been proposed as alternatives to surgical resection as therapy for intramucosal adenocarcinoma (IMC) of the esophagus. Acceptance of these alternative therapies requires an understanding of the clinical biology of IMC and the results of surgical resection modified for treatment of early disease. STUDY DESIGN: Retrospective review of 78 patients (65 men, 13 women; median age 66 years) with IMC who were treated with progressively less-extensive surgical resections (ie, en bloc, transhiatal, and vagal-sparing esophagectomy) from 1987 to 2005. RESULTS: The tumor was located in a visible segment of Barrett's esophagus in 65 (83%) and in cardia intestinal metaplasia in 13 (17%). A visible lesion was present in 53 (68%) and in all but 4 the lesion was cancer. In those patients with visible Barrett's, the tumor was within 3 cm of the gastroesophageal junction in 66% and within 1 cm in 37%. Esophagectomy was en bloc in 23, transhiatal in 31, vagal-sparing in 20, and transthoracic in 4. Operative mortality was 2.6%. Vagal-sparing esophagectomy had less morbidity, a shorter hospital stay, and no mortality. Of the patients who had en bloc resection, a median of 41 nodes were removed. One patient had one lymph node metastasis on hematoxylin and eosin staining and two others, normal on hematoxylin and eosin staining, had micrometastases on immunohistochemistry. Actuarial survival at 5 years was 88% and was similar for all types of resections. Two patients died from systemic metastases and seven from noncancer causes. CONCLUSIONS: IMC occurred in cardia intestinal metaplasia and in Barrett's esophagus. Two-thirds of patients with IMC had a visible lesion. Most tumors occurred near the gastroesophageal junction. Node metastases were uncommon, questioning the need for lymphadenectomy. A vagal-sparing technique had less morbidity than other forms of resection and no mortality. Survival after all types of resection was similar. Outcomes of endoscopic techniques should be compared with this benchmark.