Oesophagectomy for early adenocarcinoma and dysplasia arising in Barrett's oesophagus

Background: Oesophagectomy for high‐grade dysplasia is controversial. Methods: A prospective study was carried out on all patients who presented between 1993 and 2001 with dysplasia or early adeno­carcinoma who were considered fit for surgery. Details of endoscopic biopsies, appearance, surveillance, operative pathology and outcome were recorded. Results: Of 18 patients, one had low‐grade dysplasia, six had high‐grade dysplasia and 11 had early adenocarcinoma. No patient had their biopsy diagnosis down‐staged following final pathology, but two patients with high‐grade dysplasia on biopsy were upstaged to adenocarcinoma. Our only death from disease occurred in a 39‐year‐old man who had undergone yearly surveillance for 86 months until adenocarcinoma was confirmed. There was no operative mortality. Conclusion: Oesophagectomy for early adenocarcinoma and dysplasia in Barrett's oesophagus can be done with acceptable rates of mortality and morbidity. Surveillance until adenocarcinoma is confirmed does not guarantee curable disease.