Vagal-sparing Esophagectomy: The Ideal Operation for Intramucosal Adenocarcinoma and Barrett With High-Grade Dysplasia

Ann Surg. 2007 Oct;246(4):665-71; discussion 671-4. doi: 10.1097/SLA.0b013e318155a7a1.

Abstract

Objective: Our aim was to compare outcome of vagal-sparing esophagectomy with transhiatal and en bloc esophagectomy in patients with intramucosal adenocarcinoma or high-grade dysplasia.

Summary background data: Intramucosal adenocarcinoma and high grade dysplasia have a low likelihood of lymphatic or systemic metastases and esophagectomy is curative in most patients. However, traditional esophagectomy is associated with significant morbidity and altered gastrointestinal function. A vagal-sparing esophagectomy offers the advantages of complete disease removal with the potential for reduced morbidity and a better functional outcome.

Method: Retrospective review of outcome in patients with intramucosal adenocarcinoma or high grade dysplasia that had a vagal-sparing (n=49), transhiatal (n=39) or en bloc (n=21) esophagectomy.

Results: The length of hospital stay and the incidence of major complications was significantly reduced with a vagal-sparing esophagectomy compared with a transhiatal or en bloc resection. Further, postvagotomy dumping and diarrhea symptoms were significantly less common, and weight was better maintained postoperatively with a vagal-sparing esophagectomy. Recurrent cancer has developed in only 1 patient.

Conclusion: Survival with intramucosal adenocarcinoma or Barrett's with high-grade dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or high grade dysplasia.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / surgery
  • Aged
  • Barrett Esophagus / surgery
  • Body Weight / physiology
  • Diarrhea / prevention & control
  • Dumping Syndrome / prevention & control
  • Esophageal Neoplasms / surgery
  • Esophagectomy / methods*
  • Esophagus / physiopathology
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Vagus Nerve / physiology*