Carcinoma Arising In Barretts-Esophagus

During the period 1971 and 1990, 500 patients underwent resection for carcinoma of the esophagus, 51 of whom had an associated Barrett's esophagus. Of these, 49 had adenocarcinoma and two had squamous cell carcinoma. Barrett's carcinoma accounted for 23.7 percent of the surgically treated adenocarcinomas during this period. Reflux symptoms were present in 13 patients preoperatively. Tumors developed in four patients who had undergone previous antireflux operation and in two patients on the surveillance program. By postresection staging, 18 patients had stage H tumors and 33 patients had stages III and IV tumors. Stage and length of the tumor were the only prognostic determinants. The overall 90 day hospital mortality rate was 17.6 percent. The hospital mortality rate before 1986 was 22.9 percent, but decreased to 6.3 percent in the last five years. The one, two and five year survival rates were 45.9, 25.0 and 13.6 percent, respectively. The five year survival rate was significantly greater for patients with stage II (25 percent) than for patients with stages III and IV (4.5 percent) (p<0.05) and for tumor length less than 6 centimeters (21 percent) than for tumors greater than 6 centimeters (zero percent; p<0.001).