Mucosal Resection & Esophagus Sparing Surgery for Cancer of the Esophagus
by Dr. C.H. Weaver M.D. 9/2018
Historically, patients with esophageal cancer were treated with an esophagectomy-the surgical removal of the affected part of the esophagus and surrounding lymph nodes, followed by reconstruction. Barrett esophagus with high-grade dysplasia, which has a high risk of progressing to cancer, was treated the same way.
Esophagectomy is associated with significant side effects and requires major lifestyle changes. Following esophagectomy patients may have certain diet limitations and an inability to sleep horizontally. Now, an increasing number of patients with early-stage esophageal cancer or high risk Barretts esophagus appear to be effectively treated with esophagus-sparing surgery and/or ablation and progress continues to optimize this approach in appropriate individuals.
The National Comprehensive Cancer Network recently changed their guidelines for treating early-stage esophageal cancer; replacing the former gold standard of esophagectomy with an esophagus-sparing technique called endoscopic mucosal resection, (EMR) which can be combined with ablation.
About Endoscopic Mucosal Resection
Patients with esophageal tumors that appear superficially and do need invade deep into the esophagus can undergo EMR – definitive resection of the cancer or dysplastic tissue in which the esophagus is accessed via the mouth.
EMR avoids a full-thickness injury to the esophagus and is easier for patients to tolerate than esophagectomy performed by open surgery. Esophagectomy is a 6-hour operation that requires several days of postoperative recovery in the hospital and is associated with significant side effects. EMR is an outpatient procedure that requires patients to tolerate only 45 minutes of anesthesia and is associated with a better quality of life.
Pathological interpretation of the resected tissue determines if EMR needs to be followed by esophagectomy.
Endoscopic ablation is used in combination with EMR for patients with superficial cancers or as the sole treatment for selected patients with dysplastic Barrett esophagus. Ablation may be performed by either radiofrequency ablation or cryoablation. Radiofrequency ablation delivers heat energy to the lining of the esophagus, leading to tissue destruction and is administered by a balloon catheter, by a metal plate mounted at the tip of an endoscope, or by other devices. Cryoablation uses cold gases, such as liquid nitrogen or carbon dioxide, dispensed from the end of a probe to freeze and kill abnormal cells.
Individuals with suspected esophageal cancer or dysplastic Barrett esophagus should make sure they discuss these novel surgical techniques with their treating physican to see if they can avoid esophagectomy and benefit from EMR with ablation.