Download PDF
Endoscopy 2010; 42(12): 1030-1036
DOI: 10.1055/s-0030-1255858
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens

L.  Alvarez Herrero1 , 2 , R.  E.  Pouw2 , F.  G.  I.  van Vilsteren2 , F.  J.  W.  ten Kate3 , M.  Visser3 , M.  I.  van Berge Henegouwen4 , B.  L.  A.  M.  Weusten1 , J.  J.  G.  H.  M.  Bergman2
  • 1Department of Gastroenterology and Hepatology, St Antonius hospital, Nieuwegein, Netherlands
  • 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
  • 3Department of Pathology, Academic Medical Center, Amsterdam, Netherlands
  • 4Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
Further Information

Publication History

submitted 8 January 2010

accepted after revision 19 July 2010

Publication Date:
19 October 2010 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de L. Alvarez Herrero et al., pp. 1030Endoscopy 2010; 42(12): 1120-1120
DOI: 10.1055/s-0032-1306710

Background: Most risk estimations for lymph node metastasis in adenocarcinoma of the esophagus and cardia (AEC) with invasion into the muscularis mucosae (m3) or submucosa are based on surgical series. This study aimed to correlate the lymph node metastasis rate with m3 and submucosal infiltration depth of AEC in endoscopic resection specimens.

Methods: Patients undergoing endoscopic resection for AEC between January 2000 and March 2008 at two centers were included if the endoscopic resection specimen showed m3 or submucosal cancer. Infiltration into the muscularis mucosae was defined as m3. Submucosal invasion was classified as sm1 (≤ 500 µm) or sm2/3 (> 500 µm). Exclusion criteria were chemotherapy or radiotherapy and nonradical endoscopic resection.

Results: 82 patients included 57 with m3, 12 with sm1, and 13 with sm2/3 cancers. Of the tumors, 13 were poorly differentiated and five showed lymphovascular invasion. After initial endoscopic resection, seven patients underwent surgery and 75 endoscopic therapy. No lymph node metastases were found in 158 lymph nodes of the esophagectomy specimens and none of the endoscopically treated patients were diagnosed with lymph node metastasis during a median follow-up of 26 months (interquartile range [IQR] 14 – 41).

Conclusion: This study suggests that lymph node metastasis risk for m3 and submucosal AEC may be lower than has been assumed on the basis of surgical series, and that current guidelines are valid regarding suitability of m3 AECs for endoscopic therapy. It may also suggest that selected patients with submucosal cancers are also eligible for endoscopic management. Confirmation of these results is needed in larger series with longer follow-up.

References

  • 1 Botterweck A A, Schouten L J, Volovics A. et al . Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries.  Int J Epidemiol. 2000;  29 645-654
    CrossrefPubMedSearch in Google Scholar
  • 2 Bollschweiler E, Wolfgarten E, Gutschow C, Holscher A H. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males.  Cancer. 2001;  92 549-555
    CrossrefPubMedSearch in Google Scholar
  • 3 Ell C, May A, Pech O, Gossner L. et al . Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer).  Gastrointest Endosc. 2007;  65 3-10
    CrossrefPubMedSearch in Google Scholar
  • 4 Pech O, Behrens A, May A. et al . Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus.  Gut. 2008;  57 1200-1206
    CrossrefPubMedSearch in Google Scholar
  • 5 Peters F P, Kara M A, Rosmolen W D. et al . Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study.  Am J Gastroenterol. 2006;  101 1449-1457
    CrossrefPubMedSearch in Google Scholar
  • 6 Peters F P, Kara M A, Curvers W L. et al . Multiband mucosectomy for endoscopic resection of Barrett’s esophagus: feasibility study with matched historical controls.  Eur J Gastroenterol Hepatol. 2007;  19 311-315
    CrossrefPubMedSearch in Google Scholar
  • 7 Peters F P, Brakenhoff K P, Curvers W L. et al . Endoscopic cap resection for treatment of early Barrett’s neoplasia is safe: a prospective analysis of acute and early complications in 216 procedures.  Dis Esophagus. 2007;  20 510-515
    CrossrefPubMedSearch in Google Scholar
  • 8 van Lanschot J J, Hulscher J B, Buskens C J. et al . Hospital volume and hospital mortality for esophagectomy.  Cancer. 2001;  91 1574-1578
    CrossrefPubMedSearch in Google Scholar
  • 9 Araki K, Ohno S, Egashira A. et al . Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis.  Cancer. 2002;  94 570-575
    CrossrefPubMedSearch in Google Scholar
  • 10 Eguchi T, Nakanishi Y, Shimoda T. et al . Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases.  Mod Pathol. 2006;  19 475-480
    CrossrefPubMedSearch in Google Scholar
  • 11 Matsubara T, Ueda M, Abe T. et al . Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus.  Br J Surg. 1999;  86 669-673
    CrossrefPubMedSearch in Google Scholar
  • 12 Endo M, Yoshino K, Kawano T. et al . Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus.  Dis Esophagus. 2000;  13 125-129
    CrossrefPubMedSearch in Google Scholar
  • 13 Kodama M, Kakegawa T. Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan.  Surgery. 1998;  123 432-439
    CrossrefPubMedSearch in Google Scholar
  • 14 Tachibana M, Yoshimura H, Kinugasa S. et al . Clinicopathological features of superficial squamous cell carcinoma of the esophagus.  Am J Surg. 1997;  174 49-53
    CrossrefPubMedSearch in Google Scholar
  • 15 Stein H J, Feith M, Bruecher B L. et al . Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection.  Ann Surg. 2005;  242 566-573
    PubMedSearch in Google Scholar
  • 16 Westerterp M, Koppert L B, Buskens C J. et al . Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction.  Virchows Arch. 2005;  446 497-504
    CrossrefPubMedSearch in Google Scholar
  • 17 Liu L, Hofstetter W L, Rashid A. et al . Significance of the depth of tumor invasion and lymph node metastasis in superficially invasive (T1) esophageal adenocarcinoma.  Am J Surg Pathol. 2005;  29 1079-1085
    PubMedSearch in Google Scholar
  • 18 Bollschweiler E, Baldus S E, Schroder W. et al . High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas.  Endoscopy. 2006;  38 149-156
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Ancona E, Rampado S, Cassaro M. et al . Prediction of lymph node status in superficial esophageal carcinoma.  Ann Surg Oncol. 2008;  15 3278-3288
    CrossrefPubMedSearch in Google Scholar
  • 20 Hagen J A, DeMeester S R, Peters J H. et al . Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies.  Ann Surg. 2001;  234 520-530
    CrossrefPubMedSearch in Google Scholar
  • 21 Rice T W, Zuccaro Jr. G, Adelstein D J. et al . Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status.  Ann Thorac Surg. 1998;  65 787-792
    CrossrefPubMedSearch in Google Scholar
  • 22 Oh D S, Hagen J A, Chandrasoma P T. et al . Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus.  J Am Coll Surg. 2006;  203 152-161
    CrossrefPubMedSearch in Google Scholar
  • 23 Peters F P, Brakenhoff K P, Curvers W L. et al . Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus.  Gastrointest Endosc. 2008;  67 604-609
    CrossrefPubMedSearch in Google Scholar
  • 24 Hamilton S R, Aaltonen L A. Pathology and genetics of tumours of the digestive system. Lyon; IARC Press 2000
    Search in Google Scholar
  • 25 Gondrie J J, Pouw R E, Sondermeijer C M. et al . Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients.  Endoscopy. 2008;  40 359-369
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Gondrie J J, Pouw R E, Sondermeijer C M. et al . Effective treatment of early Barrett’s neoplasia with stepwise circumferential and focal ablation using the HALO system.  Endoscopy. 2008;  40 370-379
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Pouw R E, Gondrie J J, Sondermeijer C M. et al . Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection.  J Gastrointest Surg. 2008;  12 1627-1636
    CrossrefPubMedSearch in Google Scholar
  • 28 Pouw R E, Wirths K, Eisendrath P. et al . Efficacy of radiofrequency ablation combined with endoscopic resection for barrett’s esophagus with early neoplasia.  Clin Gastroenterol Hepatol. 2009;  8 23-29
    CrossrefPubMedSearch in Google Scholar
  • 29 Peters F P, Kara M A, Rosmolen W D. et al . Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 506-514
    CrossrefPubMedSearch in Google Scholar
  • 30 Peters F, Kara M, Rosmolen W, Aalders M. et al . Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection.  Endoscopy. 2005;  37 418-424
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Hulscher J B, van Sandick J W, de Boer A G. et al . Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus.  N Engl J Med. 2002;  347 1662-1669
    CrossrefPubMedSearch in Google Scholar
  • 32 Gardner M J, Altman D G. Confidence interval analysis. London; British Medical Journal 1989
    Search in Google Scholar
  • 33 Manner H, May A, Pech O, Gossner L. et al . Early Barrett’s carcinoma with ”low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent.  Am J Gastroenterol. 2008;  103 2589-2597
    CrossrefPubMedSearch in Google Scholar
  • 34 Vieth M, Stolte M. Pathology of early upper GI cancers.  Best Pract Res Clin Gastroenterol. 2005;  19 857-869
    CrossrefPubMedSearch in Google Scholar
  • 35 Pech O, May A, Gunter E. et al . The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus.  Am J Gastroenterol. 2006;  101 2223-2229
    CrossrefPubMedSearch in Google Scholar
  • 36 van Vliet E P, Heijenbrok-Kal M H, Hunink M G. et al . Staging investigations for oesophageal cancer: a meta-analysis.  Br J Cancer. 2008;  98 547-557
    CrossrefPubMedSearch in Google Scholar
  • 37 Dresner S M, Griffin S M. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy.  Br J Surg. 2000;  87 1426-1433
    CrossrefPubMedSearch in Google Scholar

J. BergmanMD, PhD 

Department of Gastroenterology and Hepatology
Academic Medical Center

Meibergdreef 9
1105 AZ, Amsterdam
The Netherlands

Fax: +31-20-6917033

Email: j.j.bergman@amc.uva.nl