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J Thorac Cardiovasc Surg 2003;126:947-949
© 2003 The American Association for Thoracic Surgery
Editorial |
a Department of Cardiothoracic Surgery, Keck School of Medicine, the University of Southern California, Los Angeles, Calif, USA
Received for publication April 1, 2003; accepted for publication April 15, 2003.
* Address for reprints: Steven R. DeMeester, MD, Assistant Professor of Cardiothoracic Surgery, Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7418, Los Angeles, CA 90033-0804, USA
sdemeester@surgery.usc.edu
| The first 20% of the full text of this article appears below. |
Barely 50 years ago, the very existence of a primary adenocarcinoma of the esophagus was debated, and this rare tumor was a novelty in comparison with squamous cell esophageal cancer. Yet in one of the most dramatic epidemiologic transformations ever recorded, adenocarcinoma has become the predominant form of esophageal cancer, and the incidence of this cancer continues to increase in all age groups in the United States.1 Although both squamous cell carcinoma and adenocarcinoma of the esophagus are deadly diseases, the existence of a precursor lesion (Barrett) for esophageal adenocarcinoma has allowed significant advances in our understanding of the pathogenesis and natural history of this cancer. Increasingly, early adenocarcinoma is detected either within a surveillance program for Barrett or fortuitously during an endoscopy to evaluate symptoms of reflux. Many of these patients have superficial tumors and are cured with surgical resection alone, disproving previously held concepts that esophageal cancer is systemic and essentially incurable in all patients at the time of diagnosis.
The increasing incidence of esophageal adenocarcinoma and the fact that many of these patients are otherwise healthy permits an accurate assessment of the natural history of the disease and the effect of specific therapies on the course of the illness. Experience at several centers has demonstrated that one of the most important predictors of both survival and the risk of systemic disease in patients with esophageal adenocarcinoma is the presence and extent of involved lymph nodes.2-5 Although the current American Joint Committee on Cancer Staging system for esophageal carcinoma only classifies disease as N0 (no
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