Surgical and endoscopic management of high grade dysplasia and early oesophageal adenocarcinoma

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Philip A Le PagePeter J Lamb

Abstract

The introduction of endoscopic techniques has led to debate about optimal management of early oesophageal adenocarcinoma. The aim was to evaluate patient selection and outcomes for endoscopic or surgical treatment at a tertiary referral centre. A prospectively collected database of consecutive patients staged with high-grade dysplasia (HGD) or T1 oesophageal adenocarcinoma treated with curative intent between 2005 and 2013 was undertaken. All patients were discussed at the multidisciplinary team meeting. Surgical treatment was by thoracoscopic assisted or standard/laparoscopic assisted Ivor Lewis oesophagectomy. Endoscopic treatment was a structured programme of endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA). Outcomes included treatment variables, recurrence and complications. 83 patients treated; 50 with endoscopic therapy (EMR only-4, EMR then RFA-22, RFA only-24) and 38 by surgery (33 straight to surgery and 5 following EMR). Median age (67) and mean follow-up (21 months) were similar. HGD was more common in the endoscopic group (32/50, 64%, vs.3/33, 9%, p = 0.0001). Significant complications were more common following surgery (13/38, 34%, vs. 1/50, 2%, p = 0.0001). There were two in-hospital deaths ...Continue Reading

Citations

Feb 15, 2017·The American Journal of Gastroenterology·Srinadh KomanduriJohn Pandolfino
May 26, 2017·Expert Opinion on Pharmacotherapy·Elfriede BollschweilerArnulf H Hölscher
Jan 11, 2017·Gastroenterology Research and Practice·Carmelo LuigianoBenedetto Mangiavillano
Oct 5, 2017·Annals of Surgical Oncology·Katrin SchwameisSteven R DeMeester
Jul 15, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Jason M DunnAndrew R Davies

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