Recent Advances in Oesophageal Adenocarcinoma

  • S. K. Mittal
  • P. K. Shah
Part of the GI Surgery Annual book series (GISA, volume 22)


The incidence of oesophageal adenocarcinoma (EAC) has risen sharply by 400 % over the past two decades in the western world [1]. Barrett’s oesophagus (BE) is believed to be the precursor lesion for EAC. EAC develops via the metaplasia–dysplasia–carcinoma sequence as a consequence of long standing gastro-oesophageal reflux disease (GERD). Caucasian race and male gender are associated with a greatly increased risk of EAC [2]. GERD, obesity, smoking and H. pylori treatment have been implicated as risk factors for the development of EAC [3]. Over the past decade several advances have been made in the assessment and management of BE and EAC. We briefly summarize the same.


National Comprehensive Cancer Network Esophageal Adenocarcinoma Enhance Recovery After Surgery High Grade Dysplasia Oesophageal Adenocarcinoma 
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  1. 1.
    Cools-Lartigue J, Spicer J, Ferri LE. Current status of management of malignant disease: Current management of esophageal cancer. J Gastrointest Surg 2015;19:964–72.CrossRefPubMedGoogle Scholar
  2. 2.
    Arnold M, Soerjomataram I, Ferlay J, Forman D. Global incidence of oesophageal cancer by histological subtype in 2012. Gut 2015;64:381–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Runge TM, Abrams JA, Shaheen NJ. Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am 2015;44:203–31.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cook MB, Corley DA, Murray LJ, Liao LM, Kamangar F, Ye W, et al. Gastroesophageal reflux in relation to adenocarcinomas of the esophagus: A pooled analysis from the Barrett’s and esophageal adenocarcinoma consortium (BEACON). PLoS One 2014;30:e103508.Google Scholar
  5. 5.
    Rubenstein JH, Taylor JB. Meta-analysis: The association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther 2010;32:1222–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kapoor H, Agrawal DK, Mittal SK. Barrett’s esophagus: Recent insights into pathogenesis and cellular ontogeny. Transl Res 2015;166:28–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011;365:1375–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Skacel M, Petras RE, Gramlich TL, Sigel JE, Richter JE, Goldblum JR. The diagnosis of low-grade dysplasia in Barrett’s esophagus and its implications for disease progression. Am J Gastroenterol 2000;95:3383–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Verbeek RE, Spittuler LF, Peute A, van Oijen MG, Ten Kate FJ, Vermeijden JR, et al. Familial clustering of Barrett’s esophagus and esophageal adenocarcinoma in a European cohort. Clin Gastroenterol Hepatol 2014;12:1656–63.e1.Google Scholar
  10. 10.
    Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ; American Gastroenterological Association. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011;140:e18–52; quiz e13.Google Scholar
  11. 11.
    Dulai GS, Guha S, Kahn KL, Gornbein J, Weinstein WM. Preoperative prevalence of Barrett’s esophagus in esophageal adenocarcinoma: A systematic review. Gastroenterology 2002;122:26–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Schneider JL, Zhao WK, Corley DA. Aspirin and nonsteroidal anti-inflammatory drug use and the risk of Barrett’s esophagus. Dig Dis Sci 2015;60:436–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Nguyen T, Tang Z, Younes M, Alsarraj A, Ramsey D, Fitzgerald S, et al. Esophageal COX-2 expression is increased in Barrett’s esophagus, obesity, and smoking. Dig Dis Sci 2015;60:65–73.CrossRefPubMedGoogle Scholar
  14. 14.
    Hvid-Jensen F, Pedersen L, Funch-Jensen P, Drewes AM. Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: A nationwide study of 9883 patients. Aliment Pharmacol Ther 2014;39:984–91.CrossRefPubMedGoogle Scholar
  15. 15.
    DeMeester SR. Antireflux surgery and the risk of esophageal adenocarcinoma: An antithetical view of the data from Sweden. Ann Surg 2013;257:583–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Hanna S, Rastogi A, Weston AP, Totta F, Schmitz R, Mathur S, et al. Detection of Barrett’s esophagus after endoscopic healing of erosive esophagitis. Am J Gastroenterol 2006;101:1416–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Espino A, Cirocco M, Dacosta R, Marcon N. Advanced imaging technologies for the detection of dysplasia and early cancer in Barrett esophagus. Clin Endosc 2014;47:47–54.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hammoud GM, Hammad H, Ibdah JA. Endoscopic assessment and management of early esophageal adenocarcinoma. World J Gastrointest Oncol 2014;6:275–88.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    van Westreenen HL, Westerterp M, Bossuyt PM, Pruim J, Sloof GW, van Lanschot JJ, et al. Systematic review of the staging performance of 18 F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 2004;22:3805–12.CrossRefPubMedGoogle Scholar
  20. 20.
    van Westreenen HL, Heeren PA, van Dullemen HM, van der Jagt EJ, Jager PL, Groen H, et al. Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations. J Gastrointest Surg 2005;9:54–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Worrell SG, Oh DS, Greene CL, Demeester SR, Hagen JA. Endoscopic ultrasound staging of stenotic esophageal cancers may be unnecessary to determine the need for neoadjuvant therapy. J Gastrointest Surg 2014; 18: 318–20. CrossRefPubMedGoogle Scholar
  22. 22.
    van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Varghese TK Jr, Hofstetter WL, Rizk NP, Low DE, Darling GE, Watson TJ, et al. The Society of Thoracic Surgeons guidelines on the diagnosis and staging of patients with esophageal cancer. Ann Thorac Surg 2013;96:346–56.CrossRefPubMedGoogle Scholar
  24. 24.
    Li Z, Rice TW. Diagnosis and staging of cancer of the esophagus and esophagogastric junction. Surg Clin North Am 2012;92:1105–26.CrossRefPubMedGoogle Scholar
  25. 25.
    Ell C, May A, Pech O, Gossner L, Guenter E, Behrens A, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc 2007;65:3–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Dubecz A, Kern M, Solymosi N, Schweigert M, Stein HJ. Predictors of lymph node metastasis in surgically resected T1 esophageal cancer. Ann Thorac Surg 2015;99:1879–86.CrossRefPubMedGoogle Scholar
  27. 27.
    Fleischer DE, Overholt BF, Sharma VK, Reymunde A, Kimmey MB, Chuttani R, et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy 2010;42:781–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Lyday WD, Corbett FS, Kuperman DA, Kalvaria I, Mavrelis PG, Shughoury AB, et al. Radiofrequency ablation of Barrett’s esophagus: Outcomes of 429 patients from a multicenter community practice registry. Endoscopy 2010;42:272–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009;360:2277–88.CrossRefPubMedGoogle Scholar
  30. 30.
    Tuttle R, Nurkin SJ, Hochwald SN. Ablative therapy for esophageal dysplasia and early malignancy: Focus on RFA. Biomed Res Int 2014;2014:642063.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Lloyd S, Chang BW. Current strategies in chemoradiation for esophageal cancer. J Gastrointest Oncol 2014;5:156–65.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Ronellenfitsch U, Schwarzbach M, Hofheinz R, Kienle P, Kieser M, Slanger TE, et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: Systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer 2013;49:3149–58.CrossRefPubMedGoogle Scholar
  33. 33.
    Luketich JD, Nguyen NT, Weigel T, Ferson P, Keenan R, Schauer P. Minimally invasive approach to esophagectomy. JSLS 1998;2:243–7.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Dantoc M, Cox MR, Eslick GD. Evidence to support the use of minimally invasive esophagectomy for esophageal cancer: A meta-analysis. Arch Surg 2012;147:768–76.CrossRefPubMedGoogle Scholar
  36. 36.
    Willer BL, Mittal SK, Worrell SG, Mumtaz S, Lee TH. Applicability and feasibility of incorporating minimally invasive esophagectomy at a high volume center. J Gastrointest Surg 2010;14:1201–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Willer BL, Worrell SG, Fitzgibbons RJ Jr, Mittal SK. Incidence of diaphragmatic hernias following minimally invasive versus open transthoracic Ivor Lewis McKeown esophagectomy. Hernia 2012;16:185–90.CrossRefPubMedGoogle Scholar
  38. 38.
    Peyre CG, Hagen JA, DeMeester SR, Altorki NK, Ancona E, Griffin SM, et al. The number of lymph nodes removed predicts survival in esophageal cancer: An international study on the impact of extent of surgical resection. Ann Surg 2008;248:549–56.CrossRefPubMedGoogle Scholar
  39. 39.
    Torgersen Z, Sundaram A, Hoshino M, Willer B, Fang X, Tashi T, et al. Prognostic implications of lymphadenectomy in esophageal cancer after neo-adjuvant therapy: A single center experience. J Gastrointest Surg 2011;15:1769–76.CrossRefPubMedGoogle Scholar
  40. 40.
    Blom RL, van Heijl M, Bemelman WA, Hollmann MW, Klinkenbijl JH, Busch OR, et al. Initial experiences of an enhanced recovery protocol in esophageal surgery. World J Surg 2013;37:2372–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Findlay JM, Tustian E, Millo J, Klucniks A, Sgromo B, Marshall RE, et al. The effect of formalizing enhanced recovery after esophagectomy with a protocol. Dis Esophagus 2014 May 18. doi:  10.1111/dote.12234 [Epub ahead of print].
  42. 42.
    Wedemeyer J, Brangewitz M, Kubicka S, Jackobs S, Winkler M, Neipp M, et al. Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system. Gastrointest Endosc 2010;71:382–6.CrossRefPubMedGoogle Scholar

Copyright information

© T.K. Chattopadhyay 2015

Authors and Affiliations

  • S. K. Mittal
    • 1
  • P. K. Shah
    • 1
  1. 1.Department of SurgeryCreighton University School of MedicineOmahaUSA

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