Department of Internal Medicine 2, HSK Wiesbaden, Germany.
Ann Surg. 2011 Jul;254(1):67-72. doi: 10.1097/SLA.0b013e31821d4bf6.
Esophagectomy has previously been the gold standard for patients with mucosal adenocarcinoma in Barrett's esophagus (Barrett's carcinoma, BC). Because of the minimal invasiveness and excellent results obtained with endoscopic resection (ER), the latter has become an accepted alternative. However, few data have so far been published comparing the 2 treatment methods.
A total of 114 patients with mucosal BC who were treated surgically or endoscopically in 2 high-volume centers were included in this study. Between 1996 and 2009, 38 patients with mucosal BC received transthoracic esophageal resection with 2-field lymphadenectomy (median 29 lymph nodes removed; all pN0) in the Department of Surgery at the University of Cologne. Seventy-six patients with BC treated with ER followed by argon-plasma-coagulation of the remaining non-dysplastic Barrett's esophagus in the Department of Gastroenterology in Wiesbaden were matched according to the following criteria: age, gender, infiltration depth (pT1m1-3), differentiation grade (G1/2 vs. 3) and follow-up period.
There were no significant differences between the 2 groups with regard to epidemiologic and tumor criteria. Complete remission (CR) was achieved in all patients in the surgery group and all but 1 patient in the ER group (98.7%; the patient died of other causes before CR was achieved). Major complications after surgery occurred in 32% of the patients, significantly more often than in the ER group (0% major complications, P < 0.001). The 90-day mortality rates were 0% in the ER group and 2.6% in the surgical group (1 of 38; P = 0.333). The median follow-up periods were 4.1 years in the ER group and 3.7 years in the surgical group. During this period, 1 patient in the ER group had a local recurrence and 4 had metachronous neoplasia (overall recurrence rate 6.6%). However, repeat endoscopic treatment was possible in all of the patients, and the long-term CR rates in the surgical and ER groups were 100% and 98.7%, respectively. No tumor-related mortality was observed in either group.
For patients with mucosal BC, both surgery and ER are effective treatment modalities. Surgery is associated with a higher morbidity rate and shows a risk for procedure-related mortality. However, the recurrence rate is higher in patients treated with ER, so that thorough follow-up procedures are mandatory.
食管切除术一直是 Barrett 食管黏膜腺癌（Barrett 癌，BC）患者的金标准。由于内镜下切除（ER）的微创性和优异效果，后者已成为一种可接受的替代方法。然而，迄今为止，很少有数据比较这两种治疗方法。
本研究共纳入了在 2 个高容量中心接受手术或内镜治疗的 114 例黏膜 BC 患者。1996 年至 2009 年，在科隆大学外科系，38 例黏膜 BC 患者接受了经胸食管切除术和 2 野淋巴结清扫术（中位数 29 个淋巴结切除；均为 pN0）。在威斯巴登胃肠病学系，76 例 BC 患者接受 ER 治疗，然后用氩等离子体凝固剩余非异型增生性 Barrett 食管，根据以下标准进行匹配：年龄、性别、浸润深度（pT1m1-3）、分化程度（G1/2 与 3）和随访期。
两组在流行病学和肿瘤标准方面无显著差异。手术组所有患者均达到完全缓解（CR），ER 组除 1 例患者外（98.7%；该患者在达到 CR 之前死于其他原因）均达到 CR。手术组有 32%的患者发生重大并发症，明显多于 ER 组（无重大并发症，P < 0.001）。ER 组 90 天死亡率为 0%，手术组为 2.6%（38 例中有 1 例；P = 0.333）。ER 组的中位随访期为 4.1 年，手术组为 3.7 年。在此期间，ER 组有 1 例局部复发，4 例发生异时性肿瘤（总复发率 6.6%）。然而，所有患者均可再次进行内镜治疗，手术组和 ER 组的长期 CR 率分别为 100%和 98.7%。两组均未观察到与肿瘤相关的死亡。
对于黏膜 BC 患者，手术和 ER 都是有效的治疗方法。手术相关发病率较高，存在与手术相关的死亡风险。然而，ER 治疗患者的复发率较高，因此必须进行彻底的随访。
