Merendino's procedure for the resection of early adenocarcinoma in Barrett's Esophagus

Introduction: Due to the endoscopic surveillance programs in patients with known Barrett's esophagus, early stage esophageal adenocarcinoma is being diagnosed with increasing frequency. The presence of lymphatic spread is the most important prognostic factor after complete tumor resection in patients with esophageal adenocarcinoma therefore radical esophagectomy and esophagogastrectomy with 2 field lymphadenectomy are the recommended treatment options in such patients. The clinical results (long-term survival) are favorable following radical surgery however the surgical intervention itself has considerable morbidity and mortality. Based on the data of large consequtive series of patients with Barrett's adenocarcinoma it seems to be an acceptable surgical treatment option to perform a limited resection of GE junction with isoperistaltic free jejunal loop interposition with preservation of vagal nerves (Merendino's procedure).

Material and methods: Between April 2008 and March 2009 three patients were operated on by Merendino's procedure in our institution: 1 of 3 because of high-grade dysplasia another one patient with proved in situ adenocarcinoma of the distal esophagus and one patient due to peptic stricture of the distal esophagus. The histological examination of the surgical specimen revealed invasive adenocarcinoma in the 67 year old male patient with the preoperative diagnosis of high-grade dysplasia. No lymph node involvement was found. Two of three patient experienced an uneventful postoperative period, in one patient a temporary leakage was observed at the level of esophago-jejunal anastomosis which healed by adequate treatment. All patients reported acceptable quality of life following the procedure.

Conclusions: our preliminary data supports the opinion that the patients with early adenocarcinoma of the distal esophagus can be managed by resection of the distal esophagus and esophago-gastric junction with regional lymphadenectomy and jejunal interposition, however further investigations are needed to determine the final value of this surgical intervention.