**10. Oesophagectomy**

HGD is associated with early invasive malignancy in up to 30% of cases, and carries a significant long-term chance of malignant progression. In addition, recurrence rates following ablative therapies are significant and endoscopic surveillance must be lifelong. For these reasons, surgical excision of the entire Barrett's segment must still be considered the 'gold standard' treatment for young, fit patients with multifocal HGD.

Oesophagectomy is the only potentially curative treatment once lymph nodes are involved. It also aims to remove the entire Barrett's segment minimising the chance of recurrence or missed metachronous lesions. Recent centralisation of cancer services has improved operative mortality to 5% or less in most specialist units. However, for patients without proven invasive cancer, this still remains a considerable risk. In addition, morbidity following oesophagectomy remains considerable although minimally invasive and vagal sparing surgery aims to minimise this and improve long-term functional outcomes. (Ell et al., 2007)
