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Adenocarcinoma in the Distal Esophagus With and Without Barrett EsophagusDifferences in Symptoms and Survival Rates
Jan Johansson, MD;
Folke Johnsson, MD, PhD;
Bruno Walther, MD, PhD;
Roger Willén, MD, PhD;
Christer Staël von Holstein, MD, PhD;
Thomas Zilling, MD, PhD
Arch Surg. 1996;131(7):708-713.
Abstract
Objective
To evaluate differences in clinical appearance and survival rates in patients operated on for adenocarcinoma in the distal esophagus with and without Barrett epithelium.
Design
Prospective clinical study.
Setting
University hospital, Sweden.
Patients
Fifty-four patients with adenocarcinoma in the distal esophagus with (n= 17) or without (n=37) Barrett epithelium.
Intervention
Esophagectomy or total gastrectomy. Main Outcome Measures: Preoperative symptoms, endoscopic results, and histological findings; postoperative morbidity, mortality, and survival rates.
Results
The main indication for the endoscopic examination that revealed tumor in the group with Barrett esophagus was reflux-related symptoms in 6 patients (routine Barrett examination, n=4; symptoms of reflux, n=2), symptoms related to upper gastrointestinal tract bleeding in 6, and malignant symptoms in 5 (dysphagia, n=4; weight loss, n= 1). In contrast, most patients in the cardia cancer group were admitted because of malignant symptoms (dysphagia, n=26; epigastric pain, n=9; and anemia, n=2). Ten of 17 patients in the Barrett esophagus cancer group had tumors limited to the mucosa and submucosa only. In 1 patient the tumor grew into the muscular layer but not through it. In the remaining 6 patients the tumor did grow through the muscular layer and lymph node metastases were found. Wall penetration was found in 30 patients and metastases to lymph nodes in 29 patients in the cardia cancer group. The hospital mortality rate was 0 of 17 patients in the Barrett cancer group and 2 of 37 patients in the cardia cancer group. In the patients operated on for adenocarcinoma in the distal esophagus, a better long-term survival rate was seen in those with Barrett epithelium (50%) than in those without this metaplasia (10%) (log rank P=.005; x2=7.80).
Conclusions
Concomitant Barrett epithelium improved the prognosis for patients with adenocarcinoma in the distal esophagus. Probably the reason for this was a higher rate of early-stage disease, because symptoms of gastroesophageal reflux and other benign disorders, not dysphagia, were most common in patients with adenocarcinoma without Barret epithelium in the distal esophagus.
Arch Surg. 1996;131:708-713
Author Affiliations
From the Departments of Surgery (Drs Johansson, Johnsson, Walther, Staël von Holstein, and Zilling) and Pathology (Dr Willén), Lund University, Lund, Sweden.
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