Esophagectomy for Superficial Esophageal Neoplasia

Endoscopic therapies have become the standard of care for most cases of Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma. Despite a rapid and dramatic evolution in treatment paradigms, esophagectomy continues to occupy a place in the therapeutic armamentarium for superficial esophageal neoplasia. The managing physician must remain cognizant of the limitations of endoscopic approaches and consider surgical resection when they are exceeded. Esophagectomy, performed at experienced centers for appropriately selected patients with early-stage disease can be undertaken with the expectation of cure as well as low mortality, acceptable morbidity, and good long-term quality of life.

Key points

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Despite the recent success of endoscopic resection and ablation in the management of Barrett’s esophagus with high-grade dysplasia and intramucosal adenocarcinoma, esophagectomy continues to play a role in the treatment of superficial esophageal neoplasia.
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The managing physician needs to be aware of the limitations of endoscopic therapies so that they are not misapplied.
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Until more data are available regarding the efficacy of endoscopic therapies for superficial submucosal carcinoma, esophagectomy with regional lymphadenectomy remains the standard of care in most operative candidates.
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When undertaken in specialty centers for appropriately selected patients, esophagectomy can be performed with a mortality of ≤1%, acceptable morbidity, and good long-term quality of life.
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When operating for early esophageal neoplasia, the surgeon should choose a technique that assures eradication of disease while minimizing the potential for perioperative morbidity and a negative impact on long-term quality of life.