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J Thorac Cardiovasc Surg 2001;122:1077-1090
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Superficial adenocarcinoma of the esophagus

From the Department of Thoracic and Cardiovascular Surgery,^a the Department of Biostatistics and Epidemiology,^b the Department of Anatomic Pathology,^c the Department of Gastroenterology,^d and the Department of Hematology and Oncology,^e The Center for Swallowing and Esophageal Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication April 28, 2000. Revisions requested Aug 14, 2000; revisions received Sept 1, 2000. Accepted for publication Nov 29, 2000. Address for reprints: Thomas W. Rice, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: ricet{at}ccf.org).

Abstract

Objective: Experience with treatment and outcome of superficial adenocarcinoma of the esophagus is limited. The purpose of this study was to evaluate the results of surgical management and identify predictors of survival.
Methods: Between September 1985 and December 1999, 122 patients underwent resection. Eighty-nine percent were men (mean age 63 ± 10 years; range 35-83 years). Sixty (49%) patients were in endoscopic surveillance programs and 48 (39%) had the preoperative diagnosis of high-grade dysplasia. Forced expiratory volume in 1 second was less than 2 L in 12 (12%). Seventy-five (61%) patients underwent transhiatal esophagectomy. Pathologic stage was N1 in 8 (7%). Pulmonary complications necessitating reintubation (respiratory failure) occurred in 10 (8%) patients. Time-related survival models were developed for decision-making (preoperative), prognosis (operative), and hospital care (postoperative).
Results: Operative mortality was 2.5%. Survival at 1, 5, and 10 years was 89%, 77%, and 68%. Preoperative decision-making factors associated with ideal outcome were 1-second forced expiratory volume of more than 2 L, surveillance, preoperative diagnosis of high-grade dysplasia, and planned transhiatal esophagectomy. Prognosis was decreased in younger patients and in those with N1 disease. Postoperative respiratory failure increased mortality.
Conclusions: Surgery is the treatment of choice for superficial adenocarcinoma of the esophagus. The ideal patient has a preoperative diagnosis of high-grade dysplasia found at surveillance, good pulmonary function, and undergoes a transhiatal esophagectomy. Discovery of N1 disease or development of postoperative respiratory failure reduces the benefits of surgery.

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