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Arch Surg. 2006 Jun;141(6):545-9; discussion 549-51.

Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer.

Author information

1
Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, Wash 98101, USA.

Abstract

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 < or = .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.

PMID:
16785354
DOI:
10.1001/archsurg.141.6.545
[Indexed for MEDLINE]

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