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High-grade dysplasia in the columnar-lined esophagus
N K Altorki1, M Sunagawa, A G Little
1Department of Surgery, New York Hospital-Cornell Medical College, New York 10021.
American Journal of Surgery
|January 1, 1991
Summary
High-grade dysplasia in a columnar-lined esophagus is a significant premalignant condition. Esophagectomy is recommended for suitable patients, as 45% were found to have carcinoma.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Abnormal columnar lining of the esophagus (Barrett's esophagus) is a premalignant condition.
- Management of high-grade dysplasia without carcinoma is controversial, with options including esophagectomy or surveillance.
- This study reviews outcomes for patients with high-grade dysplasia.
Purpose of the Study:
- To evaluate the incidence of carcinoma in patients with high-grade dysplasia.
- To assess the role of esophagectomy in managing this condition.
Main Methods:
- Retrospective review of nine patients with high-grade dysplasia on biopsy.
- Surgical intervention included esophagectomy with colon interposition or sleeve resection.
- Pathological examination of resected specimens.
Main Results:
- Four out of nine patients (45%) had carcinoma (multifocal or microinvasive).
- All patients with carcinoma had negative nodes and are long-term survivors.
- Five patients had no carcinoma identified in resected specimens.
Conclusions:
- High-grade dysplasia is a critical marker for esophageal malignancy.
- Esophagectomy should be considered for suitable candidates with high-grade dysplasia due to the high rate of occult carcinoma.