Resection for Barrett's mucosa with high-grade dysplasia: Implications for prophylactic photodynamic therapy

Objectives: Optimal therapy for Barrett's mucosa is controversial, Photodynamic therapy has recently been introduced as a technique for eradicating Barrett's mucosa with high-grade dysplasia, We sought to determine the incidence of invasive cancer and the outcomes after resection for high-grade dysplasia and to compare these results with published results of photodynamic therapy, Methods: We performed a retrospective review of patients who underwent esophagectomy for Barrett's esophagus from 1985 to 1996 and completed a metaanalysis af published results of surgery for Barrett's esophagus with high-grade dysplasia. Results: Thirteen men and two women with a mean age of 63 years underwent resection for Barrett's esophagus with high-grade dysplasia, The operation was performed through a transhiatal approach in nine and a transthoracic approach in six patients. There was no operative mortality, The final pathologic study demonstrated dysplasia in four patients, carcinoma-in-situ in three, and invasive carcinoma in eight patients (53%), AII patients are alive and none of the patients with invasive cancer has recurrent disease, A metaanalysis of published results of 119 patients undergoing resection demonstrated an operative mortality of 2.6%, an incidence of invasive cancer of 47%, and a 5-year survival in patients with invasive carcinoma of 82%, Conclusions: A substantial percentage of patients with Barrett's mucosa containing foci of high-grade dysplasia have invasive carcinoma at the time of diagnosis, Resection is accompanied by a low operative risk, achieves an escellent long-term outcome, and should remain the standard therapy for Barrett's esophagus with high-grade dysplasia.