naa a22 4500 510740642 CHVBK 20180411083027.0 cr unu---uuuuu 180411e20130901xx s 000 0 eng 10.1007/s11845-012-0890-x doi (NATIONALLICENCE)springer-10.1007/s11845-012-0890-x Evolving changes in the management of early oesophageal adenocarcinoma in a tertiary centre [Elektronische Daten] [N. O'Farrell, J. Reynolds, N. Ravi, J. Larkin, V. Malik, G. Wilson, C. Muldoon, D. O'Toole] Objectives: Series from high volume oesophageal centres highlight an increasing prevalence of early malignant (EM) lesions. The advent of endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) offer alternatives to traditional surgery. The evolution of this pattern of care in a high volume centre is analysed. Methods: Data were collected from a prospectively maintained database. 96 patients were treated with an EM lesion from 2000 to 2011. Surgery was the standard approach during the initial period (2000-2006). In 2007, with the introduction of EMR±RFA to our Centre, a rising trend toward definitive endoscopic treatment was seen. This study details the selection of cases into treatment groups and their outcomes. Results: From 2000 to 2006, 23 patients were treated with EM lesions, 96% by surgery. Seventy-three were treated from 2007 to 2011, 55% surgically and 45% by EMR±RFA. In the entire experience, there was one death from surgery and morbidity was higher in the surgery group compared with EMR±RFA (p<0.001). Three surgical patients (4.8%) relapsed with HGD or cancer, and one patient with T1N1 disease died of disease recurrence. At a median of 13months, EMR±RFA offered 100% disease control, 72% had no endoscopic or histological evidence of Barrett's oesophagus and one patient represented with low grade dysplasia. Conclusions: This study highlights the changing pattern of care in the management of early oesophageal cancer. EMR±RFA appears an acceptable alternative to surgery in carefully selected cases. However, long-term outcome analysis using these methods is required and close interdisciplinary collaboration of specialists in gastroenterology, surgery, pathology and radiology is mandatory to achieve optimum outcomes. Royal Academy of Medicine in Ireland, 2012 High grade dysplasia nationallicence Intra-mucosal carcinoma nationallicence Submucosal adenocarcinoma nationallicence Oesophagectomy nationallicence Endoscopic mucosal resection nationallicence O'Farrell N. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut Reynolds J. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut Ravi N. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut Larkin J. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut Malik V. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut Wilson G. Department of Radiology, St James's Hospital, Dublin 8, Ireland aut Muldoon C. Department of Pathology, St James's Hospital, Dublin 8, Ireland aut O'Toole D. Department of Gastroenterology, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland aut Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 363-369 0021-1265 182:3<363 2013 182 11845 https://doi.org/10.1007/s11845-012-0890-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11845-012-0890-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- O'Farrell N. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Reynolds J. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Ravi N. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Larkin J. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Malik V. Department of Surgery, Trinity College Dublin, Trinity Centre for Health Sciences, St.James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Wilson G. Department of Radiology, St James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- Muldoon C. Department of Pathology, St James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 700 1- O'Toole D. Department of Gastroenterology, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland aut NATIONALLICENCE 773 0- Irish Journal of Medical Science Springer-Verlag 182/3(2013-09-01), 363-369 0021-1265 182:3<363 2013 182 11845 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer