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[Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction].
Zentralbl Chir. 2006 Apr; 131(2):97-104.ZC

Abstract

BACKGROUND

Adenocarcinomas of the esophagogastric junction (especially Barrett's cancers) are increasingly diagnosed at early stages. The current standard treatment - radical resection with extensive lymphadenectomy - has been challenged. Limited resection or endoscopic mucosal ablation have been proposed as less invasive alternatives.

METHODS

Available data regarding limited surgical resections and endoscopic interventional procedures are evaluated with respect to short- and long-term results (mortality, morbidity, oncologic adequacy, quality of life).

RESULTS

Limited resection of the esophagogastric junction has been proven as safe (low morbidity and mortality) and oncologically adequate procedure (low rate of recurrence/excellent long-term survival) with good quality of life. The procedure meets the oncological requirements (R0-resection, complete resection of potentially tumor-infiltrated lymph nodes and the entire precancerous Barrett's esophagus). Reconstruction with interposition of a pedicled isoperistaltic jejunal loop prevents reflux and is crucial for achieving good postoperative quality of life. In contrast, endoscopic mucosal resection (EMR) carries the risk of high recurrence rates (at least 30 %). This has to be regarded as an effect of the frequent incomplete resection, multicentric tumor growth, the persistence of precancerous Barrett's mucosa and persistence of gastroesophageal reflux. Consequently, from the oncological view point, EMR is only suited for unicentric mucosal tumors (T1a) in short segments of Barrett's esophagus. Reliable preoperative identification of such tumors is, however, currently not possible.

CONCLUSION

For adequately selected patients with early Barrett's cancer, limited resection of the esophagogastric junction is an appropriate procedure. Endoscopic mucosa resection (EMR) might gain importance as staging tool.

Authors+Show Affiliations

Chirurgische Universitätsklinik, Paracelsus Medizinische Privatuniversität, Salzburg, Osterreich.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

ger

PubMed ID

16612774

Citation

von Rahden, B H A., et al. "[Limited Surgical Resection Versus Local Endoscopic Therapy of Early Cancers of the Esophagogastric Junction]." Zentralblatt Fur Chirurgie, vol. 131, no. 2, 2006, pp. 97-104.
von Rahden BH, Feith M, Stein HJ. [Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction]. Zentralbl Chir. 2006;131(2):97-104.
von Rahden, B. H., Feith, M., & Stein, H. J. (2006). [Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction]. Zentralblatt Fur Chirurgie, 131(2), 97-104.
von Rahden BH, Feith M, Stein HJ. [Limited Surgical Resection Versus Local Endoscopic Therapy of Early Cancers of the Esophagogastric Junction]. Zentralbl Chir. 2006;131(2):97-104. PubMed PMID: 16612774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction]. AU - von Rahden,B H A, AU - Feith,M, AU - Stein,H J, PY - 2006/4/14/pubmed PY - 2006/8/3/medline PY - 2006/4/14/entrez SP - 97 EP - 104 JF - Zentralblatt fur Chirurgie JO - Zentralbl Chir VL - 131 IS - 2 N2 - BACKGROUND: Adenocarcinomas of the esophagogastric junction (especially Barrett's cancers) are increasingly diagnosed at early stages. The current standard treatment - radical resection with extensive lymphadenectomy - has been challenged. Limited resection or endoscopic mucosal ablation have been proposed as less invasive alternatives. METHODS: Available data regarding limited surgical resections and endoscopic interventional procedures are evaluated with respect to short- and long-term results (mortality, morbidity, oncologic adequacy, quality of life). RESULTS: Limited resection of the esophagogastric junction has been proven as safe (low morbidity and mortality) and oncologically adequate procedure (low rate of recurrence/excellent long-term survival) with good quality of life. The procedure meets the oncological requirements (R0-resection, complete resection of potentially tumor-infiltrated lymph nodes and the entire precancerous Barrett's esophagus). Reconstruction with interposition of a pedicled isoperistaltic jejunal loop prevents reflux and is crucial for achieving good postoperative quality of life. In contrast, endoscopic mucosal resection (EMR) carries the risk of high recurrence rates (at least 30 %). This has to be regarded as an effect of the frequent incomplete resection, multicentric tumor growth, the persistence of precancerous Barrett's mucosa and persistence of gastroesophageal reflux. Consequently, from the oncological view point, EMR is only suited for unicentric mucosal tumors (T1a) in short segments of Barrett's esophagus. Reliable preoperative identification of such tumors is, however, currently not possible. CONCLUSION: For adequately selected patients with early Barrett's cancer, limited resection of the esophagogastric junction is an appropriate procedure. Endoscopic mucosa resection (EMR) might gain importance as staging tool. SN - 0044-409X UR - https://www.unboundmedicine.com/medline/citation/16612774/[Limited_surgical_resection_versus_local_endoscopic_therapy_of_early_cancers_of_the_esophagogastric_junction]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2006-921551 DB - PRIME DP - Unbound Medicine ER -