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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant Kjell Kåre Øvrebø, Haukeland University Hospital
- Second opponent: Senior Consultant Anders Edebo, Sahlgrenska University Hospital
- Third member and chair of the evaluation committee: Professor Kjersti Flatmark, University of Oslo
Chair of the Defence
Professor II Viktor Berge, University of Oslo
Principal Supervisor
Professor II Egil Johnson, University of Oslo
Summary
The curative treatment of esophageal adenocarcinoma (EAC) is surgery. Several surgical techniques exist. We have investigated the long-term outcome following two frequently used methods: hybrid minimally invasive esophagectomy (HMIE) and totally minimally invasive esophagectomy (TMIE). We found that the 5-year overall survival following HMIE and TMIE was 49% and 53%, respectively. After more than 5 years, the three main symptoms reducing health-related quality of life (HRQL) in the HMIE group were reflux (44%), fatigue (32%) and anxiety (32%). The anastomotic leakage rate was 5%. Following TMIE, the anastomotic leakage rate was 14%. Anxiety, cough and insomnia were the three most common symptoms reducing HRQL 5 years after TMIE in 35%, 32% and 27% of these patients, respectively.
Patients with dysplastic Barrett´s esophagus (BE) or superficial EAC should be treated endoscopically. After a median follow-up of 23 months, 78% of the patients with low grade dysplasia (LGD), 66% of those with high grade dysplasia (HGD) and 89% of those with T1a cancer had complete remission or histologically downstaging following endoscopic treatment (EMR and/or RFA). The post-procedural level of HRQL were satisfactory, including the absence of dysphagia in 88%.
Today, patients with BE need regular gastroscopies in order to detect any cancer transformation early. However, the majority of patients with BE will never develop cancer. In the future, targeted molecular profiling might replace some of these fruitless gastroscopies. Using tissue samples following esophagectomy as well as biopsies from non-dysplastic BE patients, we examined the prevalence of seven known molecular changes - two genetic and five epigenetic alterations. Mutations in TP53 were found in 28% of the patients in the surgical group, though not found among patients with BE. Among these seven molecular alterations, TP53 was the single alteration separating the two groups.
Additional information
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