Seminars in Thoracic and Cardiovascular Surgery
Volume 17, Issue 4 , Pages 320-325, Winter 2005

Endoscopic Mucosal Resection and Vagal-Sparing Esophagectomy for High-Grade Dysplasia and Adenocarcinoma of the Esophagus

  • Steven R. DeMeester, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to: Steven R. DeMeester, MD, Associate Professor of Cardiothoracic Surgery, 1510 San Pablo Street, Suite 514, Los Angeles, California 90033.

Department of Cardiothoracic Surgery, The University of Southern California, Keck School of Medicine, Los Angeles, California.

Once a rare tumor, adenocarcinoma of the esophagus is currently the cancer with the fastest rising incidence in America. In addition to the increasing prevalence of the disease, surveillance programs for patients with Barrett’s have led to the identification of increasing numbers of patients with high-grade dysplasia or early-stage esophageal adenocarcinomas. Although traditional esophagectomy is curative in the majority of these patients, associated morbidity and mortality remains a hurdle for patient acceptance of the procedure. New endoscopic and surgical therapies offer the potential of decreased morbidity, but do not include a lymphadenectomy, and consequently, are not appropriate in patients that have a significant risk of lymph node metastases. Endoscopic mucosal resection allows precise determination of the depth of tumor invasion and facilitates accurate local staging of early esophageal cancers. A vagal-sparing esophagectomy accomplishes the goal of removing the diseased esophagus while minimizing the physiologic impact of an esophagectomy in patients with early-stage esophageal cancer.

Keywords:  Barrett’s , dysplasia , esophageal adenocarcinoma , endoscopic mucosal resection , esophagectomy , vagus nerve

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PII: S1043-0679(05)00071-7

doi:10.1053/j.semtcvs.2005.09.001

Seminars in Thoracic and Cardiovascular Surgery
Volume 17, Issue 4 , Pages 320-325, Winter 2005