TY - JOUR
T1 - Esophagectomy for Adenocarcinoma in Patients 45 Years of Age and Younger
AU - Scott Bolton, J.
AU - Wu, Tsung Teh
AU - Yeo, Charles J.
AU - Cameron, John L.
AU - Heitmiller, Richard F.
N1 - Funding Information:
From the Departments of Surgery (J.S.B., C.J.Y., J.L.C., and RFH.) and Pathology (T-TN), The Johns Hopkins Medical Institutions, Baltimore, Md. Supported by the Lawrence Katz Thoracic Surgery Award. Reprint requests: Richard F Heitmiller, M.D., Osler 624, Johns Hopkins Hospital, Baltimore, MD 2 1136.
PY - 2001
Y1 - 2001
N2 - Esophageal adenocarcinoma in patients 45 years of age or younger is uncommon. We reviewed our experience with the surgical management of these patients to determine their clinical characteristics, pathologic findings, and treatment results. Thirty-two patients were identified through our surgical pathology database, and their medical records were reviewed to determine clinical characteristics, treatment, treatment-associated mortality, tumor staging, presence of Barrett's mucosa, and survival. In our series, patients were white (100%) males (96.9%) with a history of reflux (56.3%), cigarette smoking (40.6%), and alcohol consumption (59.4%), who presented with progressive solid food dysphagia (78.1 %). A prior diagnosis of Barrett's mucosa or use of antireflux medications was noted in five patients each (15.6%). There were no operative deaths. Actuarial survival was 81.1% (95% confidence interval [CI] 66.1 to 96.2) at 12 months, 68.5% (95% CI 49.5 to 87.5) at 24 months, and 56.9% (95% CI 34.6 to 79.1) at 60 months. Our findings show that patients with esophageal adenocarcinoma 45 years of age or younger have similar clinical findings to those reported in other large series where the median age is in the sixth or seventh decade of life, supporting a uniform theory of tumor pathogenesis. Esophagectomy may be performed with low mortality, and survival is reasonable for early-stage disease. Young patients with Barrett's esophagus are not immune from the development of adenocarcinoma and need to be screened accordingly.
AB - Esophageal adenocarcinoma in patients 45 years of age or younger is uncommon. We reviewed our experience with the surgical management of these patients to determine their clinical characteristics, pathologic findings, and treatment results. Thirty-two patients were identified through our surgical pathology database, and their medical records were reviewed to determine clinical characteristics, treatment, treatment-associated mortality, tumor staging, presence of Barrett's mucosa, and survival. In our series, patients were white (100%) males (96.9%) with a history of reflux (56.3%), cigarette smoking (40.6%), and alcohol consumption (59.4%), who presented with progressive solid food dysphagia (78.1 %). A prior diagnosis of Barrett's mucosa or use of antireflux medications was noted in five patients each (15.6%). There were no operative deaths. Actuarial survival was 81.1% (95% confidence interval [CI] 66.1 to 96.2) at 12 months, 68.5% (95% CI 49.5 to 87.5) at 24 months, and 56.9% (95% CI 34.6 to 79.1) at 60 months. Our findings show that patients with esophageal adenocarcinoma 45 years of age or younger have similar clinical findings to those reported in other large series where the median age is in the sixth or seventh decade of life, supporting a uniform theory of tumor pathogenesis. Esophagectomy may be performed with low mortality, and survival is reasonable for early-stage disease. Young patients with Barrett's esophagus are not immune from the development of adenocarcinoma and need to be screened accordingly.
KW - Adenocarcinoma
KW - Barrett's
KW - Esophageal neoplasm
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U2 - 10.1016/S1091-255X(01)80104-9
DO - 10.1016/S1091-255X(01)80104-9
M3 - Article
C2 - 12086900
AN - SCOPUS:0035502369
SN - 1091-255X
VL - 5
SP - 620
EP - 625
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 6
ER -