[Adenocarcinoma of the thoracic esophagus in reflux disease]

Organic reflux disease is a pre-cancerous state. Adenocarcinoma characterized by aggressive growth, poor prognosis, rapid lymphatic and haematological spread and a technically challenging operation were found to develop in the middle or distal third of the oesophagus in 26 of a series of 262 cases (endobrachyoesophagus, grade 2 reflux oesophagitis). Only 7 of the 26 were operable of whom only 2 survived for 2--3 years. This stresses the importance of clear guidelines for a timely operation in lessening the danger of the evolving reflux disease. Comprehensive long-term controls are necessary to know whether surgery aimed at impeding the reflux element has been successful.