Department of Medicine, VA North Texas Healthcare System, The University of Texas Southwestern Medical Center at Dallas, USA.
Am J Gastroenterol. 2012 Jun;107(6):850-62; quiz 863. doi: 10.1038/ajg.2012.78.
Endoscopic eradication therapy is used to treat mucosal neoplasms in Barrett's esophagus, but cannot cure cancers that have metastasized to lymph nodes. The risk of such metastases has been proposed as a reason to consider esophagectomy rather than endoscopic therapy for esophageal mucosal neoplasia. The objective of our study was to determine the frequency of lymph-node metastases in patients with high-grade dysplasia (HGD) and intramucosal carcinoma in Barrett's esophagus.
We performed a systematic review using the PRISMA guidelines to identify studies that included patients who had esophagectomy for HGD or intramucosal carcinoma in Barrett's esophagus, and that reported final pathology results after examination of esophagectomy specimens.
We identified 70 relevant reports that included 1,874 patients who had esophagectomy performed for HGD or intramucosal carcinoma in Barrett's esophagus. Lymph-node metastases were found in 26 patients (1.39 % , 95 % CI 0.86 – 1.92). No metastases were found in the 524 patients who had a final pathology diagnosis of HGD, whereas 26 (1.93 % , 95 % CI 1.19 – 2.66 %) of the 1,350 patients with a final pathology diagnosis of intramucosal carcinoma had positive lymph nodes.
The risk of unexpected lymph-node metastases for patients with mucosal neoplasms in Barrett's esophagus is in the range of 1 – 2 %. Esophagectomy has a mortality rate that often exceeds 2 %, with substantial morbidity and no guarantee of curing metastatic disease. Therefore, the risk of lymph node metastases alone does not warrant the choice of esophagectomy over endoscopic therapy for HGD and intramucosal carcinoma in Barrett's esophagus.
内镜下根除治疗用于治疗 Barrett 食管的黏膜肿瘤，但不能治愈已转移至淋巴结的癌症。淋巴结转移的风险被认为是考虑行食管切除术而不是内镜治疗 Barrett 食管黏膜肿瘤的原因之一。本研究的目的是确定 Barrett 食管高级别异型增生（HGD）和黏膜内癌患者中淋巴结转移的频率。
我们使用 PRISMA 指南进行了系统评价，以确定包括因 HGD 或 Barrett 食管黏膜内癌而行食管切除术且报告了食管切除标本检查后的最终病理结果的患者的研究。
我们确定了 70 项相关报告，其中包括 1874 例因 HGD 或 Barrett 食管黏膜内癌而行食管切除术的患者。26 例（1.39%，95%CI 0.86-1.92%）发现淋巴结转移。524 例最终病理诊断为 HGD 的患者中未发现转移，而 1350 例最终病理诊断为黏膜内癌的患者中有 26 例（1.93%，95%CI 1.19-2.66%）有阳性淋巴结。
Barrett 食管黏膜肿瘤患者发生意外淋巴结转移的风险在 1%-2%之间。食管切除术的死亡率通常超过 2%，且发病率较高，并不能保证治愈转移性疾病。因此，仅淋巴结转移的风险并不足以证明在 Barrett 食管的 HGD 和黏膜内癌中选择食管切除术优于内镜治疗。
