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Endoscopic Treatment of Premalignant and Early Esophageal Malignancy

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Minimally Invasive Foregut Surgery for Malignancy

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Abstract

Barrett’s esophagus (BE) is a well-known risk factor for esophageal adenocarcinoma, and progression of metaplasia through dysplasia to adenocarcinoma is a widely accepted theory of esophageal carcinogenesis. High-grade dysplasia (HGD) has a high risk of progression to cancer, and esophageal resection (esophagectomy) has been recommended as a standard surgical therapy to treat HGD based on the previous studies demonstrating that the incidence of concomitant invasive cancer in the surgically resected specimens of patients with biopsy-proven HGD has been reported to be approximately 40 %. Esophagectomy is one of the most invasive surgeries in the upper gastrointestinal tract and is associated with high mortality and morbidity even with the recent refinement of surgical techniques and perioperative care. Given that lymph node involvement in patients with HGD and T1a cancer is unlikely (<2 %), esophagectomy may be unreasonably invasive. However, patients with HGD and T1a cancer have a chance for cure of disease, although overall prognosis of esophageal cancer is poor with 5-year survival of approximately 15 % despite multidisciplinary approaches including chemoradiation and surgical therapy. Therefore, it is extremely important to determine what the best approach is for this population to accomplish cure without residual or recurrent disease, while minimizing the postoperative morbidity and mortality.

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Author information

Authors and Affiliations

  1. Department of Surgery, Institute for the Treatment of Esophageal and Thoracic Disease, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Suite 4600, Pittsburgh, PA, 15224, USA

    Toshitaka Hoppo MD, PhD

  2. Department of Surgery, Institute for the Treatment of Esophageal and Thoracic Disease, The Western Pennsylvania Hospital, Pittsburgh, PA, USA

    Blair A. Jobe MD, FACS

Authors
  1. Toshitaka Hoppo MD, PhD
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  2. Blair A. Jobe MD, FACS
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Correspondence to Toshitaka Hoppo MD, PhD .

Editor information

Editors and Affiliations

  1. Roswell Park Cancer Institute, Vice-Chair and Chief of GI Surgery Department of Surgical Oncology, Buffalo, New York, USA

    Steven N. Hochwald

  2. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA

    Moshim Kukar

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Hoppo, T., Jobe, B.A. (2015). Endoscopic Treatment of Premalignant and Early Esophageal Malignancy. In: Hochwald, S., Kukar, M. (eds) Minimally Invasive Foregut Surgery for Malignancy. Springer, Cham. https://doi.org/10.1007/978-3-319-09342-0_2

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  • DOI: https://doi.org/10.1007/978-3-319-09342-0_2

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