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J Thorac Cardiovasc Surg 1997;114:824-829
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

RESECTION FOR BARRETT'S MUCOSA WITH HIGH-GRADE DYSPLASIA: IMPLICATIONS FOR PROPHYLACTIC PHOTODYNAMIC THERAPY

Received for publication May 6, 1997 revisions requested June 30, 1997; revisions received July 21, 1997 accepted for publication July 21, 1997. Address for reprints: Mark K. Ferguson, MD, Chief, Section of Thoracic Surgery, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave., MC5035, Chicago, IL 60637.

Abstract

Objectives: Optimal therapy for Barrett's mucosa is controversial. Photodynamic therapy has recently been introduced as a technique for eradicating Barrett's mucosa with high-grade dysplasia. We sought to determine the incidence of invasive cancer and the outcomes after resection for high-grade dysplasia and to compare these results with published results of photodynamic therapy. Methods: We performed a retrospective review of patients who underwent esophagectomy for Barrett's esophagus from 1985 to 1996 and completed a metaanalysis of published results of surgery for Barrett's esophagus with high-grade dysplasia. Results: Thirteen men and two women with a mean age of 63 years underwent resection for Barrett's esophagus with high-grade dysplasia. The operation was performed through a transhiatal approach in nine and a transthoracic approach in six patients. There was no operative mortality. The final pathologic study demonstrated dysplasia in four patients, carcinoma-in-situ in three, and invasive carcinoma in eight patients (53%). All patients are alive and none of the patients with invasive cancer has recurrent disease. A metaanalysis of published results of 119 patients undergoing resection demonstrated an operative mortality of 2.6%, an incidence of invasive cancer of 47%, and a 5-year survival in patients with invasive carcinoma of 82%. Conclusions: A substantial percentage of patients with Barrett's mucosa containing foci of high-grade dysplasia have invasive carcinoma at the time of diagnosis. Resection is accompanied by a low operative risk, achieves an excellent long-term outcome, and should remain the standard therapy for Barrett's esophagus with high-grade dysplasia.

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