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June 1, 2006

Outcomes and Health-Related Quality of Life After Esophagectomy for High-Grade Dysplasia and Intramucosal Cancer

Author Affiliations

Author Affiliations: Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, Wash.

Arch Surg. 2006;141(6):545-551. doi:10.1001/archsurg.141.6.545

Hypothesis  The reported morbidity and mortality associated with esophagectomy for high-grade dysplasia (HGD) and intramucosal cancer (IMC) have led asymptomatic patients to consider less invasive and possibly less effective treatments. This study provides a critical assessment of outcomes and health-related quality of life (HRQL) after esophagectomy for HGD and IMC.

Design  Cohort analytic study.

Setting  Section of thoracic surgery at a tertiary referral center.

Patients  All patients who presented between May 1991 and February 2003 with a biopsy-proven diagnosis of Barrett esophagus with HGD or IMC were assessed.

Main Outcome Measures  Prospective analysis of postoperative morbidity, mortality, HRQL, and gastrointestinal symptoms.

Results  Follow-up was complete in 36 patients. Mean follow-up was 4.9 years (range, 0.5-12.0 years). The incidence of postoperative invasive cancer was 39%, with stages ranging from I to IIB. There were 4 major complications (11%) and no operative mortality. Twenty-eight patients were alive, with a cancer-free survival of 85%. The HRQL outcomes (Medical Outcomes Study 36-Item Short-Form Health Survey) were comparable with those of age- and sex-matched controls. Significant differences in postesophagectomy gastrointestinal symptoms were seen with a decreased incidence of heartburn (P≤.001) and increased requirement for a slower speed of eating. Twenty-two (79%) of the 28 patients described their current eating pattern as “normal or insignificantly impacted.”

Conclusions  Esophagectomy for HGD and IMC can be accomplished with low morbidity and mortality. Furthermore, most patients are able to resume a normal eating pattern, and postoperative HRQL can be equivalent to that of the general population.