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Artigos Originais • Rev. Col. Bras. Cir. 26 (5) • Out 1999 • https://doi.org/10.1590/S0100-69911999000500008   copiar

Esofagectomia transiatal para o tratamento do adenocarcinoma do esôfago

Transhiatal esofagectomy for adenocarcinoma of the esophagus

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumos

A esofagite de refluxo associada ao epitélio de colunar do esôfago predispõe ao adenocarcinoma, cuja incidência vem aumentando nos últimos anos. Entre 1976 e 1993, os autores trataram 11 pacientes com adenocarcinoma primário do esôfago. Em dois casos, a neoplasia desenvolveu-se em epitélio colunar ectópico no esôfago cervical e torácico. Nos demais casos, ocorreu no terço distal do esôfago em epitélio colunar de Barrett, em pacientes com sintomas clínicos de esofagite de refluxo, dos quais sete eram portadores de hérnia de hiato e refluxo gastroesofágico previamente documentados. Nove pacientes foram submetidos a esofagectomia transiatal com esofagogastroplastia, um foi submetido a esofagectomia distal com interposição de jejuno e o último a esofagogastroplastia retroestemal sem esofagectomia. A exceção de três pacientes, os demais tiveram operações consideradas curativas. Cinco doentes encontravam-se em estádios mais iniciais, ainda sem comprometimento linfonodal. Não houve mortalidade operatória, sendo que as principais complicações foram a fístula da anastomose esofagogástrica e a abertura da cavidade pleural, ambas ocorrendo em dois pacientes. A sobrevida média dos pacientes foi de 40,5 meses. Três pacientes permanecem vivos e sem evidência de doença (estádio 0, I e IIA) com 64, 94 e 117 meses de seguimento. Concluiu-se que a esofagectomia neste tipo de tumor é um procedimento seguro e que a sobrevida a longo prazo é possível quando os tumores em estadio inicial são tratados adequadamente.

Câncer do esôfago; Tumor do esôfago; Neoplasia do esôfago; Adenocarcinoma do esôfago; Esôfago de Barrett

Esophagitis associated with Barretts esophagus is a recognized predisponent factor for the development of adenocarcinoma. its incidence has been raising through the last years. Between 1976 and 1993, eleven patients with primary adenocarcinoma of the esophagus were treated. In two cases, the neoplasia occurred in an aberrant gastric mucosa in the cervical and thoracic esophagus. in the remaining cases, the tumor occurred in the distal third of the organ. in columnar-lined (Barretts) esophagus, in patients with hiatal hernia and gastroesophageal refluxo Nine patients were submitted to transhiatal esophagectomy. one to distal esophagectomy with interposition of jejunum. and one to retrosternal esophagogastroplasty without esophagectomy. All but three patients had curative operations. Five patients had early stage disease, without limphonode involvement. There was no operative mortality and the main complications were anastomotic leackage and openning of pleural cavity, both of them occurring, in two patients. The average survival of these patients was 40.5 months. Three patients remain alive and with no evidence of recurrence (Stage 0, I and IIA), with a follow-up of 64, 94 and 117 months. Patients with gastroesophagic reflux and Barretts esophagus must be properly treated and they need endoscopic surveillance for the evaluation of progressive dysplasia or adenocarcinoma. The authors conclude that esophagectomy is a safe procedure and long term survival is possible when these esophageal tumors are treated in the early stages.

Cancer of the esophagus; Tumor of the esophagus; Neoplasia of the esophagus; Adenocarcinoma of the esophagus; Barretts esophagus

ARTIGOS ORIGINAIS

Esofagectomia transiatal para o tratamento do adenocarcinoma do esôfago

Transhiatal esofagectomy for adenocarcinoma of the esophagus

Dino Antonio Oswaldo Altmann, TCBC-SPI; Fábio de Oliveira FerreiraII; Roberto Anania de Paula, TCBC-SPII; Eugênio Américo Bueno Ferreira, TCBC-SPIII

IDoutor pelo Departamento de Cirurgia da FMUSP

IIMédico do Departamento de Cirurgia Pélvica do Hospital A. C. Camargo - SP

IIIProfessor Associado do Departamento de Cirurgia da FMUSP. Professor Titular da Disciplina de Técnica Cirúrgica da Faculdade de Medicina de Jundiaí

Endereço para correspondência Endereço para correspondência: Dr. Dino Antonio Oswaldo Altmann Rua Jesuíno Arruda, 676 cj. 131 04532-082 - São Paulo - SP E-mail: altmand@ibm.net

RESUMO

A esofagite de refluxo associada ao epitélio de colunar do esôfago predispõe ao adenocarcinoma, cuja incidência vem aumentando nos últimos anos. Entre 1976 e 1993, os autores trataram 11 pacientes com adenocarcinoma primário do esôfago. Em dois casos, a neoplasia desenvolveu-se em epitélio colunar ectópico no esôfago cervical e torácico. Nos demais casos, ocorreu no terço distal do esôfago em epitélio colunar de Barrett, em pacientes com sintomas clínicos de esofagite de refluxo, dos quais sete eram portadores de hérnia de hiato e refluxo gastroesofágico previamente documentados. Nove pacientes foram submetidos a esofagectomia transiatal com esofagogastroplastia, um foi submetido a esofagectomia distal com interposição de jejuno e o último a esofagogastroplastia retroestemal sem esofagectomia. A exceção de três pacientes, os demais tiveram operações consideradas curativas. Cinco doentes encontravam-se em estádios mais iniciais, ainda sem comprometimento linfonodal. Não houve mortalidade operatória, sendo que as principais complicações foram a fístula da anastomose esofagogástrica e a abertura da cavidade pleural, ambas ocorrendo em dois pacientes. A sobrevida média dos pacientes foi de 40,5 meses. Três pacientes permanecem vivos e sem evidência de doença (estádio 0, I e IIA) com 64, 94 e 117 meses de seguimento. Concluiu-se que a esofagectomia neste tipo de tumor é um procedimento seguro e que a sobrevida a longo prazo é possível quando os tumores em estadio inicial são tratados adequadamente.

Unitermos: Câncer do esôfago; Tumor do esôfago; Neoplasia do esôfago; Adenocarcinoma do esôfago; Esôfago de Barrett.

ABSTRACT

Esophagitis associated with Barretts esophagus is a recognized predisponent factor for the development of adenocarcinoma. its incidence has been raising through the last years. Between 1976 and 1993, eleven patients with primary adenocarcinoma of the esophagus were treated. In two cases, the neoplasia occurred in an aberrant gastric mucosa in the cervical and thoracic esophagus. in the remaining cases, the tumor occurred in the distal third of the organ. in columnar-lined (Barretts) esophagus, in patients with hiatal hernia and gastroesophageal refluxo Nine patients were submitted to transhiatal esophagectomy. one to distal esophagectomy with interposition of jejunum. and one to retrosternal esophagogastroplasty without esophagectomy. All but three patients had curative operations. Five patients had early stage disease, without limphonode involvement. There was no operative mortality and the main complications were anastomotic leackage and openning of pleural cavity, both of them occurring, in two patients. The average survival of these patients was 40.5 months. Three patients remain alive and with no evidence of recurrence (Stage 0, I and IIA), with a follow-up of 64, 94 and 117 months. Patients with gastroesophagic reflux and Barretts esophagus must be properly treated and they need endoscopic surveillance for the evaluation of progressive dysplasia or adenocarcinoma. The authors conclude that esophagectomy is a safe procedure and long term survival is possible when these esophageal tumors are treated in the early stages.

Key words: Cancer of the esophagus; Tumor of the esophagus; Neoplasia of the esophagus; Adenocarcinoma of the esophagus; Barretts esophagus.

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Full text available only in PDF format.

REFERÊNCIAS

1. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265; 1.287-1.289.

2. Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar lined (Barrett's) esophagus. N Engl J Med 1985;313; 857-859.

3. De Meester TR, Attwood SEA, Smyurk TC, et al. Surgical therapy in Barrett's esophagus. Ann Surg 1990;212:528-542.

4. Streitz Jr JM, Ellis Jr FH, Gibb SP, et al. Adenocarcinoma in Barrett's esophagus. A clinicopathologic study of 65 cases. Ann Surg 1991; 213:122-125.

5. Roth JA, Putnan Jr lB, Rich TA, et al. Cancer of the Esophagus. In De Vila Jr VT, Hellman S, Rosenberg AS - Cancer - Principies & Practice of Oncology. 5th Edition. Philadelphia: Lippincott-Raven Publishers, 1997, pp 997.

6. American Joint Commitee on Cancer. Esophagus. In: Beahrs OH, Henson DE, Hutter RVP, et al – Manual for staging of cancer. 4th edition. Philadelphia: JB Lippincott, 1992, pp57.

7. Barrett NR. Chronic peptic ulcer of the oesophagus and oesophagitis. Britsh Surg 1950;38:175-182.

8. Bremmer CG, Lynch Vp, Ellis Jr FH. Barrett's esophagus: congenital or acquired? An experimental study of esophageal mucosa regeneration in dog. Surgery 1970;68:209-216.

9. Winters Jr C, Spurling TJ, Chobanian SJ, et al. Barrett's esophagus. A prevalent, occult complication of gastro-esophageal reflux disease. Gastroenterology 1987;92:118-124.

10. Borrie J. Goldwater L. Columnar cell-lined esophagus: assessment of etiology and treatment. A 22-year-experience. J Thorac Cardiovasc Surg 1976;71:825-834.

11. Burbige EJ, Radigan JI. Characteristics of the columnar-cell-lined (Barrett's) esophagus. Gastrointest Endosc 1979;25:133-136.

12. GOSPE (Gruppo Operativo per 10 Studio delle Precancerosi dell'Esofago). Barrett's esophagus: epidemiological and clinical results of multicentric survey. Int J Cancer 1991 ;48:364-368.

13. Hameeteman W, Tytgat GNJ, Houthoff HJ, et al. Barrett's esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 1989;96:1.249-1.256.

14. Wiu TR, Bains MS, Zaman MB, et al. Adenocardinoma in Barrett's esophagus. Thorac Cardiovasc Surg 1983;85:337-344.

15. Payne WS, McAfee M, Trastek V,et al. Adenocarcinoma of the columnar epithelial-lined lower esophagus of Barrett. In Delarue NC, Wilkins E, Wong J: International Trends in General Thoracic Surgery: esophageal cancer 2th edition. SI. Louis: CV Mosby, 1988, pp 256-261, v.4.

16. Skinner DB, Walther BC, Riddell RH. Barrett's esophagus: comparison of benign and malignant case. Ann Surg 1983;198:554-565.

17. Cameron AJ, Lomboy CT, Peca M, et al. Adenocarcinoma of the esophagogastric junction and Barrett's esophagus, Gastroenterology 1995;109:1,541-1,546,

18, Williamson WA, Ellis FH, Oibb SP, et al. Effect of antireflux operation on Barrett's mucosa. Ann Thorac Surg 1990;49:537-542.

19. Hamilton SR, Hutcheon DF, Ravich WJ, et al. Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal refluxo Gastroenterology 1984;86:356-360.

20. Altorki NK, Sunagawa M, Little AO, et al. High-grade dysplasia in the columnar-lined esophagus. Am J Surg 1991; 161:97 -100.

21. Altorki NK, Skinner DB, Segalin A, et al. lndications for esophagectomy in nonmalignant Barrett's esophagus: a 10-year experience. Ann Thorac Surg 1990;49:724-726.

22. Sai di F. Endoesophageal pull through. A technique for the treatment of cancers of the cardia and lower esophagus. Ann Surg 1988; 207: 446-454.

23. Saidi F, Abbassi A, Shadmehr MB, et al. Endothoracic endoesophageal pull-through operation. A new approach to cancers of the esophagus and proximal stomach. J Thorac Cardiovasc Surg 1991;102:43-50.

24. Skinner DB. En bloc resection for neoplasma of the esophagus and cardia. J Thorac Cardiovasc Surg 1983;85:59-71.

25. KusterOOR, Foroozan. P-Early diagnosis of adenocarcinoma developing in Barrett's esophagus. Arch Surg 1989;124:925-928.

26. Holscher AH, Bollschweiler E, Bumm R, et al. Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 1995;118:845-855.

27. Anderson LL, Lad TE. Autopsy findings in squamous-cell carcinoma of the esophagus. Cancer 1982;50:1.587-1.582.

28. Casson AO, Manolopoulos B, Troster M, et al. Clinical implications of p53 gene mutation in the progression of Barrett's epithelium to invasive esophageal cancer. Am J Surg 1994;167:52-57.

29. Fennerty MB, Sampliner RE, Way D, et al. Discordance between flow-cytometric abnormality and dysplasia in Barrett's esophagus. Gastroenterology 1989;97:815-820.

30. Rabinovitch PS, Reid BJ, Haggitt RC, et al. Progression to cancer in Barrett's esophagus in association with genomic instability. Lab Invest 1988;60:65-71.

31. Ireland AP, Clark OWB, DeMeesterTR, et al. Barrett's esophagus: the significance of p53 in clinical practice. Ann Surg 1997;225: 17-30.

Recebido em 4/12/97

Aceito para publicação em 13/9/99

Trabalho realizado no Hospital Sírio-Libanês - SP.

  • 1. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265; 1.287-1.289.
  • 2
    Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar lined (Barrett's) esophagus. N Engl J Med 1985;313; 857-859.
  • 3. De Meester TR, Attwood SEA, Smyurk TC, et al. Surgical therapy in Barrett's esophagus. Ann Surg 1990;212:528-542.
  • 4. Streitz Jr JM, Ellis Jr FH, Gibb SP, et al. Adenocarcinoma in Barrett's esophagus. A clinicopathologic study of 65 cases. Ann Surg 1991; 213:122-125.
  • 5. Roth JA, Putnan Jr lB, Rich TA, et al. Cancer of the Esophagus. In De Vila Jr VT, Hellman S, Rosenberg AS - Cancer - Principies & Practice of Oncology. 5th Edition. Philadelphia: Lippincott-Raven Publishers, 1997, pp 997.
  • 6. American Joint Commitee on Cancer. Esophagus. In: Beahrs OH, Henson DE, Hutter RVP, et al Manual for staging of cancer. 4th edition. Philadelphia: JB Lippincott, 1992, pp57.
  • 7. Barrett NR. Chronic peptic ulcer of the oesophagus and oesophagitis. Britsh Surg 1950;38:175-182.
  • 8. Bremmer CG, Lynch Vp, Ellis Jr FH. Barrett's esophagus: congenital or acquired? An experimental study of esophageal mucosa regeneration in dog. Surgery 1970;68:209-216.
  • 9. Winters Jr C, Spurling TJ, Chobanian SJ, et al. Barrett's esophagus. A prevalent, occult complication of gastro-esophageal reflux disease. Gastroenterology 1987;92:118-124.
  • 10. Borrie J. Goldwater L. Columnar cell-lined esophagus: assessment of etiology and treatment. A 22-year-experience. J Thorac Cardiovasc Surg 1976;71:825-834.
  • 11. Burbige EJ, Radigan JI. Characteristics of the columnar-cell-lined (Barrett's) esophagus. Gastrointest Endosc 1979;25:133-136.
  • 12. GOSPE (Gruppo Operativo per 10 Studio delle Precancerosi dell'Esofago). Barrett's esophagus: epidemiological and clinical results of multicentric survey. Int J Cancer 1991 ;48:364-368.
  • 13. Hameeteman W, Tytgat GNJ, Houthoff HJ, et al. Barrett's esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 1989;96:1.249-1.256.
  • 14. Wiu TR, Bains MS, Zaman MB, et al. Adenocardinoma in Barrett's esophagus. Thorac Cardiovasc Surg 1983;85:337-344.
  • 15. Payne WS, McAfee M, Trastek V,et al. Adenocarcinoma of the columnar epithelial-lined lower esophagus of Barrett. In Delarue NC, Wilkins E, Wong J: International Trends in General Thoracic Surgery: esophageal cancer 2th edition. SI. Louis: CV Mosby, 1988, pp 256-261, v.4.
  • 16. Skinner DB, Walther BC, Riddell RH. Barrett's esophagus: comparison of benign and malignant case. Ann Surg 1983;198:554-565.
  • 17. Cameron AJ, Lomboy CT, Peca M, et al. Adenocarcinoma of the esophagogastric junction and Barrett's esophagus, Gastroenterology 1995;109:1,541-1,546,
  • 18, Williamson WA, Ellis FH, Oibb SP, et al. Effect of antireflux operation on Barrett's mucosa. Ann Thorac Surg 1990;49:537-542.
  • 19. Hamilton SR, Hutcheon DF, Ravich WJ, et al. Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal refluxo Gastroenterology 1984;86:356-360.
  • 20. Altorki NK, Sunagawa M, Little AO, et al. High-grade dysplasia in the columnar-lined esophagus. Am J Surg 1991; 161:97 -100.
  • 21. Altorki NK, Skinner DB, Segalin A, et al. lndications for esophagectomy in nonmalignant Barrett's esophagus: a 10-year experience. Ann Thorac Surg 1990;49:724-726.
  • 22. Sai di F. Endoesophageal pull through. A technique for the treatment of cancers of the cardia and lower esophagus. Ann Surg 1988; 207: 446-454.
  • 23. Saidi F, Abbassi A, Shadmehr MB, et al. Endothoracic endoesophageal pull-through operation. A new approach to cancers of the esophagus and proximal stomach. J Thorac Cardiovasc Surg 1991;102:43-50.
  • 24. Skinner DB. En bloc resection for neoplasma of the esophagus and cardia. J Thorac Cardiovasc Surg 1983;85:59-71.
  • 25. KusterOOR, Foroozan. P-Early diagnosis of adenocarcinoma developing in Barrett's esophagus. Arch Surg 1989;124:925-928.
  • 26. Holscher AH, Bollschweiler E, Bumm R, et al. Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 1995;118:845-855.
  • 27. Anderson LL, Lad TE. Autopsy findings in squamous-cell carcinoma of the esophagus. Cancer 1982;50:1.587-1.582.
  • 28. Casson AO, Manolopoulos B, Troster M, et al. Clinical implications of p53 gene mutation in the progression of Barrett's epithelium to invasive esophageal cancer. Am J Surg 1994;167:52-57.
  • 29. Fennerty MB, Sampliner RE, Way D, et al. Discordance between flow-cytometric abnormality and dysplasia in Barrett's esophagus. Gastroenterology 1989;97:815-820.
  • 30. Rabinovitch PS, Reid BJ, Haggitt RC, et al. Progression to cancer in Barrett's esophagus in association with genomic instability. Lab Invest 1988;60:65-71.
  • 31. Ireland AP, Clark OWB, DeMeesterTR, et al. Barrett's esophagus: the significance of p53 in clinical practice. Ann Surg 1997;225: 17-30.

  • Endereço para correspondência:

    Dr. Dino Antonio Oswaldo Altmann
    Rua Jesuíno Arruda, 676 cj. 131
    04532-082 - São Paulo - SP
    E-mail:

    • Datas de Publicação

    • Publicação nesta coleção
      24 Nov 2009
    • Data do Fascículo
      Out 1999

    Histórico

    • Aceito
      13 Set 1999
    • Recebido
      04 Dez 1997
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