Background
Endoscopic resection in patients with superficial esophageal squamous carcinoma (SESC)
is limited by the presence of lymph node metastasis (LNM), highlighting the importance
of determining which patients have virtually no risk of LNM.
Objective
To investigate the clinicopathological parameters predicting LNM in patients who underwent
esophagectomy for SESCs and to identify the best candidate patients for endoscopic
resection.
Design
Retrospective, single-center study.
Setting
Tertiary-care center.
Patients
A total of 190 patients who underwent esophagectomy for SESCs between 1991 and 2009.
Interventions
Esophagectomy with lymph node dissection.
Main Outcome Measurements
LNM.
Results
Of 190 patients, 39 (20.5%) had LNM. The rates of LNM in patients with m1, m2, m3,
sm1, sm2, and sm3 lesions were 0.0% (0/18), 8.7% (4/46), 25.0% (6/24), 15.0% (3/20),
26.0% (7/27), and 37.3% (19/51), respectively. On multivariate analysis, lymphovascular
invasion (LVI) (P < .001), superficial tumor size (P = .004), and lower LMM (lamina muscularis mucosae) invasion width (P < .001) were independent predictors of LNM in patients with SESC invading the LMM.
Among 63 patients with mucosal or sm1 cancer 3 cm or smaller, only 1 had LNM without
LVI showing a lower LMM invasion width greater than 3.0 mm.
Limitations
Retrospective analysis.
Conclusions
Endoscopic resection should be performed for mucosal cancer of 3 cm or less without
positive lymph nodes. Moreover, if pathological examination of the endoscopically
resected specimens shows invasion of the sm1 layer and a lower LMM invasion width
of 3.0 mm or less, indicating an absence of LVI, the patient can be carefully observed
without additional treatment.
Abbreviations:
LMM (lamina muscularis mucosae), LNM (lymph node metastasis), LVI (lymphovascular invasion), SESC (superficial esophageal squamous carcinoma)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 10, 2011
Accepted:
December 18,
2010
Received:
November 3,
2010
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Jung at [email protected]
Identification
Copyright
© 2011 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
