gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

Comparison of endoscopic and surgical therapy for Barrett’s esophagus with T1a early adenocarcinoma – a single center experience in the US.

Meeting Abstract

  • Henner Schmidt - Virginia Mason Medical Center, Department for General, Vascular and Thoracic Surgery, Seattle
  • Artur M. Bodnar - Virginia Mason Medical Center, Department for General, Vascular and Thoracic Surgery, Seattle
  • Andrew Ross - Virginia Mason Medical Center, Department for General, Vascular and Thoracic Surgery, Seattle
  • Shayan Irani - Virginia Mason Medical Center, Department of Hepatology and Gastroenterology, Seattle
  • Ian Gan - Virginia Mason Medical Center, Department of Hepatology and Gastroenterology, Seattle
  • Donald E. Low - Virginia Mason Medical Center, Department for General, Vascular and Thoracic Surgery, Seattle

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch170

doi: 10.3205/14dgch170, urn:nbn:de:0183-14dgch1703

Veröffentlicht: 21. März 2014

© 2014 Schmidt et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Endoscopic therapy for T1a adenocarcinoma in Barrett’s esophagus showed promising results and has become an accepted alternative to esophagectomy. However there is little contemporary data comparing endoscopic therapy to surgical management.

Material and methods: A total of 87 patients with T1a adenocarcinoma in Barrett’s esophagus were treated between January 2000 and July 2013 at Virginia Mason Medical Center. All patients were initially assessed with endoscopy and endoscopic ultrasound. 44 patients were treated endoscopically, all patient got endoscopic mucosa resection, either alone (48%) or in combination with other ablational therapy (52%). All 43 patients treated surgically had open transthoracic procedures with 2-field lymph node resection. Patient demographics and outcomes are assessed between the two groups.

Results: There were no difference in gender distribution. Surgical patients were younger than endoscopically treated patients (mean age 64.7 vs 69.95 (p=0.014y). Comorbidities were higher in the endoscopic group (as demonstrated by Charlson score 5.1 vs 3.97 p=0.015). There is no significant difference in mean Barrett length, distribution of multifocal diseases and endoscopic Paris classification between both groups. In the surgical group in-hospital mortality are zero, R0 tumor and Barretts resection rate was 100% and mean length of stay was 10.3 days (7-24 days). 11 patients (26%) had a T-stage higher than T1a with nodal disease in 4 patients (9%). Overall survival in the surgical group was 76.7% after a mean follow up of 73.6 months (1-146 months). In the endoscopic group a mean of 8.73 endoscopic procedures (range 3-26) were performed in each patient. Overall survival was 65% after a mean follow up of 51.6 months (1-177 months). 16 patients (36%) had persistent dysplasia or intramucosal carcinoma present at the time of their last follow up.

Conclusion: Esophagectomy and endoscopic treatment are both safe and feasible. While patients with higher comorbidities are more often treated endoscopically, length of Barrett segment, multifocal disease and Paris classification are not significant different in both groups. Esophageal resection provide definitive treatment for the Barretts and cancer while confirming accurate pathologic stage. Endoscopic treatment is a good option in selected patients but requires multiple procedures and long term surveillance.