Background: Barrett’s esophagus is a premalignant condition caused by longstanding gastroesophageal reflux disease and may progress to low-grade dysplasia, high-grade dysplasia (HGD), and finally esophageal adenocarcinoma. Summary: Barrett’s adenocarcinoma can be treated either by endoscopic or surgical resection, depending on the clinical staging. Endoscopic resection is a safe and adequate treatment option for HGD, mucosal tumors, and low-risk submucosal tumors. Its role in the treatment of high-risk submucosal tumors and the role of organ-preserving sentinel node navigated surgery are still under investigation. Esophagectomy with neoadjuvant chemoradiation or perioperative chemotherapy is considered the standard of care for locally advanced Barrett’s adenocarcinoma. Regarding operative technique, there is no proven superiority of one technique over another, although a minimally invasive transthoracic technique seems most commonly applied nowadays. In this review, state-of-the-art evidence and future expectations are presented regarding indications for resection, neoadjuvant or perioperative therapy, type of surgery, and postoperative follow-up for Barrett’s adenocarcinoma. Key Messages: In Barrett’s adenocarcinoma, endoscopic resection is the standard treatment option for low-risk mucosal and submucosal tumors. For high-risk submucosal tumors, endoscopic submucosal dissection with close surveillance and sentinel node navigated surgery are currently being studied. For locally advanced cancer, a multimodal therapy including esophagectomy is the standard of care. Nowadays, in high-volume centers, a minimally invasive transthoracic esophagectomy with an intrathoracic anastomosis is the most common procedure for Barrett’s adenocarcinoma.
Visc Med

中文翻译：

---

巴雷特腺癌手术治疗中今天的错误和明天的智慧

背景：巴雷特食管是由长期胃食管反流病引起的癌前病变，可能进展为低度不典型增生、高度不典型增生 (HGD)，最后发展为食管腺癌。摘要：巴雷特腺癌可以通过内窥镜或手术切除进行治疗，具体取决于临床分期。内镜切除术是 HGD、粘膜肿瘤和低风险粘膜下肿瘤的安全且充分的治疗选择。其在治疗高危粘膜下肿瘤中的作用以及保留器官的前哨淋巴结导航手术的作用仍在研究中。食管切除术联合新辅助放化疗或围手术期化疗被认为是局部晚期巴雷特腺癌的标准治疗方法。关于手术技术，虽然目前最常用的是微创经胸技术，但尚未证明一种技术优于另一种技术。在这篇综述中，提出了关于巴雷特腺癌的切除指征、新辅助或围手术期治疗、手术类型和术后随访的最新证据和未来期望。关键信息：在巴雷特腺癌中，内镜切除是低风险粘膜和粘膜下肿瘤的标准治疗选择。对于高危粘膜下肿瘤，目前正在研究密切监测的内镜粘膜下剥离术和前哨淋巴结导航手术。对于局部晚期癌症，包括食管切除术在内的多模式治疗是标准治疗方法。如今，在大容量中心，微创经胸食管切除术和胸内吻合术是治疗巴雷特腺癌的最常见手术。
内脏医学