Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus.

BACKGROUND & AIMS Photodynamic therapy (PDT) for high-grade dysplasia (HGD) in Barrett's esophagus is a Food and Drug Administration-approved alternative to esophagectomy. Critical information regarding overall survival of patients followed up long-term after these therapies is lacking. Our aim was to compare the long-term survival of patients treated with PDT with patients treated with esophagectomy. METHODS We reviewed records of patients with HGD seen at our institution between 1994 and 2004. PDT was performed 48 hours following the intravenous administration of a photosensitizer using light at 630 nm. Esophagectomy was performed by either transhiatal or transthoracic approaches by experienced surgeons. We excluded all patients with evidence of cancer on biopsy specimens. Vital status and death date information was queried using an institutionally approved Internet research and location service. Statistical analysis was performed using Kaplan-Meier curves and Cox proportional hazards ratios. RESULTS A total of 199 patients were identified. A total of 129 patients (65%) were treated with PDT and 70 (35%) with esophagectomy. Overall mortality in the PDT group was 9% (11/129) and in the surgery group was 8.5% (6/70) over a median follow-up period of 59 +/- 2.7 months for the PDT group and 61 +/- 5.8 months for the surgery group. Overall survival was similar between the 2 groups (Wilcoxon test = 0.0924; P = .76). Treatment modality was not a significant predictor of mortality on multivariate analysis. CONCLUSIONS Overall mortality and long-term survival in patients with HGD treated with PDT appears to be comparable to that of patients treated with esophagectomy.

[1]  C. Pellegrini,et al.  Long-term outcome of esophagectomy for high-grade dysplasia or cancer found during surveillance for barrett’s esophagus , 2006, Journal of Gastrointestinal Surgery.

[2]  Kenneth K Wang,et al.  Frozen section analysis of esophageal endoscopic mucosal resection specimens in the real-time management of Barrett's esophagus. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  S. DeMeester.  Endoscopic mucosal resection and vagal-sparing esophagectomy for high-grade dysplasia and adenocarcinoma of the esophagus. , 2005, Seminars in thoracic and cardiovascular surgery.

[4]  Michael Vieth,et al.  Prevalence of Barrett's esophagus in the general population: an endoscopic study. , 2005, Gastroenterology.

[5]  M. Solaymani-Dodaran,et al.  Mortality Associated with Barrett's Esophagus and Gastroesophageal Reflux Disease Diagnoses—A Population-Based Cohort Study , 2005, The American Journal of Gastroenterology.

[6]  G. Falk.  Barrett's Esophagus—Is It Bad for Your Health? , 2005, The American Journal of Gastroenterology.

[7]  R. Cestari,et al.  Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: an Italian experience. , 2005, World journal of gastroenterology.

[8]  V. Sujendran,et al.  Oesophagectomy remains the gold standard for treatment of high-grade dysplasia in Barrett's oesophagus. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  Bergein F Overholt,et al.  Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett's esophagus: international, partially blinded, randomized phase III trial. , 2005, Gastrointestinal endoscopy.

[10]  L. Gossner,et al.  Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett's cancer and high-grade intraepithelial neoplasia. , 2005, Gastrointestinal endoscopy.

[11]  B. Edil,et al.  Surgical treatment of esophageal high-grade dysplasia. , 2005, The Annals of thoracic surgery.

[12]  Ashesh B Jani,et al.  An electronic application for rapidly calculating Charlson comorbidity score , 2004, BMC Cancer.

[13]  Masoud Panjehpour,et al.  Photodynamic therapy for Barrett's esophagus with dysplasia and/or early stage carcinoma: long-term results. , 2003, Gastrointestinal endoscopy.

[14]  A. Gavin,et al.  Mortality in Barrett’s oesophagus: results from a population based study , 2003, Gut.

[15]  B. Overholt,et al.  What is the best management strategy for high grade dysplasia in Barrett’s oesophagus? A cost effectiveness analysis , 2003, Gut.

[16]  R. Heitmiller.  Prophylactic esophagectomy in Barrett esophagus with high-grade dysplasia , 2003, Langenbeck's Archives of Surgery.

[17]  J. Birkmeyer,et al.  Hospital volume and surgical mortality in the United States. , 2002, The New England journal of medicine.

[18]  J. Luketich,et al.  Outcomes of minimally invasive esophagectomy (MIE) for high-grade dysplasia of the esophagus. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[19]  P. Pairolero,et al.  High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. , 2002, The Annals of thoracic surgery.

[20]  S. Spechler,et al.  Clinical practice. Barrett's Esophagus. , 2002, The New England journal of medicine.

[21]  V. Eckardt,et al.  Life expectancy and cancer risk in patients with Barrett's esophagus: a prospective controlled investigation. , 2001, The American journal of medicine.

[22]  Dennis M. Riehle,et al.  Extent of high-grade dysplasia in Barrett's esophagus correlates with risk of adenocarcinoma. , 2001, Gastroenterology.

[23]  A. Sonnenberg,et al.  Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia. , 2001, Gastroenterology.

[24]  R. Sandler,et al.  Is there publication bias in the reporting of cancer risk in Barrett's esophagus? , 2000, Gastroenterology.

[25]  Prateek Sharma,et al.  Long-term follow-up of Barrett's high-grade dysplasia , 2000, American Journal of Gastroenterology.

[26]  Gary Longton,et al.  Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets , 2000, American Journal of Gastroenterology.

[27]  Patricia L. Blount,et al.  Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. , 2000 .

[28]  A. Weston,et al.  Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma , 1999, American Journal of Gastroenterology.

[29]  U. Ladabaum,et al.  Barrett's Esophagus with High-Grade Dysplasia , 1999 .

[30]  G. Falk,et al.  The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: Report on the cleveland clinic barrett's esophagus registry , 1999, American Journal of Gastroenterology.

[31]  R. D'Agostino.  Adjustment Methods: Propensity Score Methods for Bias Reduction in the Comparison of a Treatment to a Non‐Randomized Control Group , 2005 .

[32]  A. Cameron,et al.  Barrett's esophagus, high-grade dysplasia, and early adenocarcinoma: a pathological study. , 1997, The American journal of gastroenterology.

[33]  S. Re,et al.  The incidence of adenocarcinoma in Barrett's esophagus: a prospective study of 170 patients followed 4.8 years. , 1997 .

[34]  R. Heitmiller,et al.  Barrett's esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy. , 1996, Annals of surgery.

[35]  J. Richardson,et al.  The rationale for esophagectomy as the optimal therapy for Barrett's esophagus with high-grade dysplasia. , 1996, Annals of surgery.

[36]  P. Lawler,et al.  An assessment of the consistency of ASA physical status classification allocation , 1995, Anaesthesia.

[37]  T. Rice,et al.  Surgical management of high-grade dysplasia in Barrett's esophagus. , 1993, The American journal of gastroenterology.

[38]  P. Pairolero,et al.  Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy? , 1992, The Annals of thoracic surgery.

[39]  N. Walker,et al.  Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus. , 1991, Gut.

[40]  W S Payne,et al.  The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus. , 1985, The New England journal of medicine.

[41]  Navtej S Buttar,et al.  Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus. , 2007, Gastrointestinal endoscopy.

[42]  M. Eloubeidi,et al.  Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus , 2002 .

[43]  P. Schauer,et al.  Laparoscopic Transhiatal Esophagectomy for Barrett's Esophagus with High Grade Dysplasia , 1998, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[44]  R. Sampliner,et al.  The incidence of adenocarcinoma in Barrett's esophagus: a prospective study of 170 patients followed 4.8 years. , 1997, The American journal of gastroenterology.

[45]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.