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Query: UMLS:C0154059 (Esophagus)
 2,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)


Dis Esophagus 1997 Apr
PMID:What's new in pathology, pathophysiology and conservative treatment of benign esophageal disorders? 917 89

The authors analyzed 230 cases of T1 cancer of the thoracic esophagus resected in our surgical department between 1985 and 1996. This study showed that mucosal cancer was superior to submucosal cancer with respect to the 5-year survival rate (84% vs 64%), the incidence of lymph node metastasis (2% vs 42%) and the incidence of vascular invasion (8% vs 79%); therefore, the true early cancer of the esophagus can be defined as mucosal cancer of the esophagus. As for endoscopic classification, 93% of the 0-IIb subtype lesion and 80% of the 0-IIc subtype were mucosal cancer. Endoscopic staining with Lugol's solution can produce more precise information in the diagnosis of such flat lesions. Important points in screening for the detection of mucosal cancer of the esophagus include: (i) esophagoscopy for patients with only slight esophageal symptoms; (ii) annual endoscopic examination for high-risk populations; and (iii) endoscopic staining with Lugol's solution for abnormal findings on conventional endoscopy.
Dis Esophagus 1997 Jul
PMID:Detection and classification of early squamous cell esophageal cancer. 928 71

To decide the extent of resection and lymphadenectomy in early esophageal cancer, accurate diagnosis at the preoperative stage is essential. Because in mucosal cancer lymph node metastasis is hardly ever seen, minimal invasive surgery, by endoscopic mucosal resection is indicated. On the other hand, for submucosal cancer lymph node metastasis the rate is as high as 26-45%, therefore, standard resection and systematic lymphadenectomy is indicated, corresponding to that for advanced cancer. In Japan the 5-year survival rate after resection is 98-100% for mucosal cancer and 67-90% for submucosal cancer.
Dis Esophagus 1997 Jul
PMID:Extent of resection and lymphadenectomy in early squamous cell esophageal cancer. 928 72

Between 1980 and 1995, 91 (13.7%) out of 666 patients were determined by pathologic staging to have a superficial squamous-cell esophageal carcinoma of the thoracic esophagus. The male to female ratio was 3.3:1, and the mean age 60 years. Postoperative mortality was 4.3%. The median follow-up was 48 months (range 3-179). Survival was significantly decreased with increased depth of tumour invasion and presence of nodal metastases (P=0.03). Recurrent disease was prevalent in patients with submucosal tumours compared to those with mucosal tumours (P < 0.05). Only intra-epithelial and intramucosal carcinomas deserve the definition of 'early' tumours. Given the relative inaccuracy of current staging modalities and the low morbidity and mortality rates associated with surgical resection, surgery appears to be the mainstay of treatment of superficial squamous-cell esophageal cancer.
Dis Esophagus 1997 Jul
PMID:Prognosis of early squamous cell carcinoma of the esophagus after surgical therapy. 928 73


Dis Esophagus 1997 Jul
PMID:Role of surveillance endoscopy, biopsy and biomarkers in early detection of Barrett's adenocarcinoma. 928 74

The recognition of Barrett's esophagus as a premalignant condition has led to aggressive endoscopic screening protocols aimed at detecting adenocarcinoma in this organ. This policy has resulted in an increasing number of patients who present with 'early Barrett's cancer'. In the existing literature, very little data address patients with these lesions and, therefore, no consistent definition of early Barrett's cancer currently exists. Additionally, the extent of resection and lymphadenectomy that should be performed is not known. We define early Barrett's cancer as clinical T1N0M0 adenocarcinoma. We perform en bloc esophagectomy with radical lymphadenectomy for these lesions because current data suggest that a more radical operation may improve survival in patients with esophageal cancer. It is also the only way to stage adequately the tumour and is associated with morbidity and mortality rates comparable to less radical, 'standard' resections in experienced hands. Barrett's esophagus is associated with invasive adenocarcinoma in 40% of patients who undergo esophagectomy for the preoperative diagnosis of high-grade dysplasia. The existing literature suggests these lesions may represent the earliest subset of Barrett's cancer and that a standard, less radical resection may suffice for these patients.
Dis Esophagus 1997 Jul
PMID:Extent of resection and lymphadenectomy in early Barrett's cancer. 928 75


Dis Esophagus 1997 Jul
PMID:Prognostic differences between early squamous-cell and adenocarcinoma of the esophagus. 928 76

Barrett's esophagus carries a 10-15% lifetime risk of malignant change, and dysplasia may be an early indication of such transformation. Endoscopic surveillance is widely practised but guidelines have not been established. A questionnaire regarding surveillance protocols was sent to all consultants in the Trent Region performing endoscopy (n = 79), of whom 58 (73%) replied. Surveillance is performed by 52 clinicians (90%), but the interval varies between 1 and 3 years. Routine biopsies are only taken by 38 (65%), of which 74% are taken randomly. Detection of low-grade dysplasia would lead 32 (62%) to reduce the surveillance interval. For high-grade dysplasia, a reduced surveillance interval or surgery is advocated by 36 (69%) and 13 (25%), respectively. Most clinicians (74%) discontinue surveillance at age 70 or 75. Surveillance of Barrett's esophagus is variable, especially in the presence of dysplasia. No surveillance guidelines are available, but most respondents (79%) believe these would help.
Dis Esophagus 1997 Jul
PMID:Surveillance of Barrett's esophagus: a need for guidelines? 928 77

The study compares, in true adenocarcinoma of the cardia and in adenocarcinoma in Barrett's esophagus, the prevalence of early cancers and their outcome in those patients suitable for resection surgery. From 1980 to 1993, 26 of 350 (7.4%) resected adenocarcinomas of the esophago-gastric junction were pathologically staged as early cancer or pT1. The prevalence of early cancer was 3.7% (11/294) for true cancer of the cardia and 27% (15/56) for cancer in Barrett's esophagus (P < 0.001). Ten of the 15 latter cancers were diagnosed during endoscopic surveillance for benign Barrett's esophagus. Among early cancers, there were four mucosal and 22 submucosal tumours; of the latter, eight had lymph node metastasis and seven neoplastic permeation of lympho-hematic vessels. The most frequently used surgical procedure was esophago-gastric resection and gastric pull-up. Postoperative morbidity was 15.4%, and hospital mortality 3.8%. Excluding postoperative deaths, the overall 5-year survival rate was 79% for early cancer of the cardia and 83% for early cancer in Barrett's esophagus (log rank test = 0.0214, P = 0.88). Overall, the survival rate was 100% in the absence of lymph node metastasis and 43% in the presence of node metastasis (log rank test = 15.811, P = 0.0001). Only one of five patients with both node metastasis and vessel infiltration survived longer than 5 years. In conclusion, the prevalence of early cancer was significantly greater for cancer in Barrett's esophagus than for true cancer of the cardia. Prognosis of the two types of tumour after resection surgery was the same and depended on lymph node status and neoplastic permeation of lympho-hematic vessels.
Dis Esophagus 1997 Jul
PMID:Prevalence, management and outcome of early adenocarcinoma (pT1) of the esophago-gastric junction. Comparison between early cancer in Barrett's esophagus (type I) and early cancer of the cardia (type II). 928 78

Helicobacter pylori (HP) plays a crucial role in gastric carcinogenesis. Few studies have looked at the relationship between HP and Barrett's esophagus/cancer. To further investigate this, a study comparing the prevalence of HP and increasing grades of dysplasia was undertaken. Biopsies from 19 malignant and 94 benign cases of Barrett's esophagus were analysed histologically for the presence of HP. 34% of non-dysplastic Barrett's epithelium was colonized with HP compared with only 17% of dysplastic/malignant cases (P = 0.04). No relationship was found between HP status and: (i) length of Barrett's esophagus; (ii) the presence of ulcers or strictures; and (iii) previous anti-reflux surgery. HP colonization of Barrett's esophagus is not uncommon. We found that HP has a negative correlation with increasing dysplasia which is analogous to gastric carcinogenesis. This finding should be investigated in prospective studies to elucidate its role in Barrett's adenocarcinoma.
Dis Esophagus 1997 Jul
PMID:Helicobacter pylori colonization of Barrett's esophagus and its progression to cancer. 928 79


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