Wolfsen Herbert C, Hemminger Lois L, DeVault Kenneth R
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
BMC Gastroenterol. 2004 Aug 25;4:18. doi: 10.1186/1471-230X-4-18.
Esophagectomy is considered the gold standard for the treatment of high-grade dysplasia in Barrett's esophagus (BE) and for noninvasive adenocarcinoma (ACA) of the distal esophagus. If all of the metaplastic epithelium is removed, the patient is considered "cured". Despite this, BE has been reported in patients who have previously undergone esophagectomy. It is often debated whether this is "new" BE or the result of an esophagectomy that did not include a sufficiently proximal margin. Our aim was to determine if BE recurred in esophagectomy patients where the entire segment of BE had been removed.
Records were searched for patients who had undergone esophagectomy for cure at our institution. Records were reviewed for surgical, endoscopic, and histopathologic findings. The patients in whom we have endoscopic follow-up are the subjects of this report.
Since 1995, 45 patients have undergone esophagectomy for cure for Barrett's dysplasia or localized ACA. Thirty-six of these 45 patients underwent endoscopy after surgery including 8/45 patients (18%) with recurrent Barrett's metaplasia or neoplasia after curative resection.
Recurrent Barrett's esophagus or adenocarcinoma after esophagectomy was common in our patients who underwent at least one endoscopy after surgery. This appears to represent the development of metachronous disease after complete resection of esophageal disease. Half of these patients have required subsequent treatment thus far, either repeat surgery or photodynamic therapy. These results support the use of endoscopic surveillance in patients who have undergone "curative" esophagectomy for Barrett's dysplasia or localized cancer.
食管切除术被认为是治疗巴雷特食管（BE）高级别异型增生及食管远端非侵袭性腺癌（ACA）的金标准。如果所有化生上皮均被切除，患者即被视为“治愈”。尽管如此，有报道称曾接受食管切除术的患者中仍出现了BE。对于这是“新发”BE还是食管切除术近端切缘不足所致，一直存在争议。我们的目的是确定在已切除全部BE节段的食管切除患者中BE是否会复发。
检索本机构接受根治性食管切除术患者的记录。对手术、内镜及组织病理学检查结果进行回顾。本报告的研究对象为接受内镜随访的患者。
自1995年以来，45例患者因巴雷特异型增生或局限性ACA接受了根治性食管切除术。这45例患者中有36例术后接受了内镜检查，其中8例（18%）在根治性切除术后出现了复发性巴雷特化生或肿瘤形成。
在我们的患者中，术后至少接受过一次内镜检查的患者，食管切除术后复发性巴雷特食管或腺癌很常见。这似乎代表了食管疾病完全切除后异时性疾病的发生。迄今为止，这些患者中有一半需要后续治疗，要么再次手术，要么接受光动力治疗。这些结果支持对因巴雷特异型增生或局限性癌症接受“根治性”食管切除术的患者进行内镜监测。
