TECAD Cirurgia Digestiva Practice Questions - TECAD - Título De Especialista Em Cirurgia Do Aparelho Digestivo (CBCD AMB) Exam

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A 64-year-old man with long-standing Barrett's esophagus undergoes surveillance high-definition chromoendoscopy. A flat 12 mm slightly elevated lesion (Paris 0-IIa) is identified at the 5 o'clock position, 3 cm above the gastroesophageal junction. Endoscopic Submucosal Dissection (ESD) is performed. Histopathology confirms a well-differentiated intramucosal adenocarcinoma (pT1a-m3) with clear lateral and deep resection margins (R0), no lymphovascular invasion, and no submucosal infiltration. What is the standard oncological management following this resection?

Immediate transthoracic esophagectomy (Ivor Lewis) with two-field lymphadenectomy Systemic adjuvant chemotherapy with 5-FU and oxaliplatin (FOLFOX) Definitive external beam chemoradiation to the distal esophagus and celiac nodes Endoscopic eradication therapy (e.g., Radiofrequency Ablation - RFA) of the remaining Barrett's mucosa combined with endoscopic surveillance

Correct Answer:

Endoscopic eradication therapy (e.g., Radiofrequency Ablation - RFA) of the remaining Barrett's mucosa combined with endoscopic surveillance

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