ADENOCARCINOMA IN BARRETTS ESOPHAGUS

Abstract

The association of adenocarcinoma with Barrett''s esophagus stimulated a review to study the clinical presentation, pathology and results of management. Nineteen patients (15 men and 4 women) satisfied the criteria of primary adenocarcinoma arising in columnar epithelium in the esophagus. The majority had dysphagia (95%) and weight loss (63%). Nearly 3/4 of the patients also had a history of hiatal hernia or esophagitis. Diagnosis was confirmed preoperatively in all by endoscopic biopsy and/or cytologic study. Potentially curative resection was performed in 15 patients and palliative procedures in 4. Fourteen patients had advanced (Stage III) disease and only 5 had Stage I or II disease. Multicentric disease within the esophagus was found in 7 patients. Postoperative complications included empyema, hemothorax and pneumonia (1 case each). The only postoperative death resulted from complications of previously undetected brain metastases. The median survival of the 15 patients having resection for cure is 12 mo. Four are alive, 1 with disease at 46 mo. and 3 free of disease at 19, 86 and 93 mo. All 4 patients undergoing palliative procedures died within 8 mo. Multifocal presentation of the tumor is common in this group of patients and long-term survival is possible when early tumors are managed aggressively.