[Surgical treatment of Barrett carcinoma]

Barrett-carcinoma is a type of adenocarcinoma of the distal esophagus and the cardia. Barrett-esophagus is defined by the histologic presence of specialized epithelium with intestinal metaplasia. As a consequence Barrett-carcinoma has a close relationship to the adenocarcinoma of the cardia and is very often part of the cardiacarcinoma type I. The aim of the surgical therapy is a radical R0-resection of the tumor including the lymphatic drainage area. This aim is accomplished among different authors by different surgical concepts. One is the radical transhiatal subtotal esophagectomy with lymphadenectomy in the lower mediastinum and the upper abdominal compartments. The other concept is a transthoracic en-bloc esophagectomy. Both resection procedures are usually completed by gastric pull up reconstruction. Currently a sophisticated preoperative staging is followed by distinguished indication and therapy depending on tumor status, risk factors of the patient and on the international classification of the cardia carcinoma (Siewert). When a R0-resection is impossible, a neoadjuvant radiochemotherapy should be performed.