Original CommunicationsMinimally invasive esophagectomy for Barrett’s esophagus with high-grade dysplasia☆
Section snippets
Methods
From August 1996 to February 1999, 12 consecutive patients underwent minimally invasive esophagectomy for biopsy-proven BE/HGD at the University of Pittsburgh Medical Center. Our consort consisted of 7 men and 5 women; average age was 64 years (range, 40-78 years). During this time period, one patient with BE/HGD was treated nonsurgically because of her advanced age and poor performance status. Biopsy specimens in all 12 patients were reviewed and confirmed to be accurate by 2 experienced
Results
All 12 patients underwent successful minimally invasive esophagectomy without conversion to laparotomy or thoracotomy (Table I).Patient no. Age (y)/Gender Procedure Diagnosis Pathology ICU stay (d) LOS (d) 1 55/F LTE BE/HGD BE/HGD 1 4 2 77/M LM/TE BE/HGD BE/HGD 2 13 3 55/M LM/TE BE/HGD Adenocarcinoma in situ 1 6 4 58/M LM/TE BE/HGD BE/HGD 6 12 5 70/F LM/TE BE/HGD Adenocarcinoma in situ 2 7 6 73/M LM/TE BE/HGD BE/HGD 1 5 7 66/M LM/TE BE/HGD
Discussion
What constitutes the optimal management for patients with BE/HGD remains controversial. Surgical resection is the most definitive curative treatment, but concern about high morbidity and mortality associated with esophagectomy has influenced some clinicians to consider other options such as endoscopic biopsy surveillance, PDT, or endoscopic mucosectomy.3, 4, 5 The rationale for endoscopic surveillance is that some patients with BE/HGD will not progress to develop invasive cancer. The Hines VA
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2010, Current Problems in Surgery
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Reprint requests: Ninh T. Nguyen, MD, Department of Surgery, 4301 X St, Sacramento, CA 95817-2214.