Barrett’s esophagus and adenocarcinoma

The first slide to give you a typical history is a patient I saw about a year ago, a man of 61, who came with a complaint of three months of increasing dysphagia for solid foods, which were sticking at the chest level. When asked, he also had a 30-year history of heartburn and sour reflux, for which he had never sought other treatment except taking antacids, so this had never been investigated. In the population, there are many people with heartburn who have not had it investigated. A barium x-ray was done at his home hospital and this showed an esophageal ulcer with what was called edema. However, they recognized that it wasn’t just edema and did an endoscopy at his home hospital, which showed an adenocarcinoma and a Barrett’s esophagus which had not been recognized previously.

The results of treatment of patients of this type are unfortunately not very good. This shows the results of surgical resection in seven fairly large series. Here are the numbers of patients who had resection for adenocarcinoma of the esophagus and here is the mortality rate. While these series may have been written a few years ago, the median mortality here was about 8%. Here is the complication rate. The median complication rate here was about 40%, with such problems as anastomotic leaks, pneumonia, postoperative strictures and empyemas. This is difficult surgery. For all that the patients went through, and the surgeons, the five-year survival was not very great. The median five-year survival for patients presenting with a mass in the esophagus which was an adenocarcinoma in these series was about 15%. How could we do better? This is a very brief review of a lot of literature in the oncology and radiation area.