Endoscopy 2007; 39(1): 36-40
DOI: 10.1055/s-2006-945148
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma

K.  Higuchi1 , S.  Tanabe1 , W.  Koizumi1 , T.  Sasaki1 , K.  Nakatani1 , K.  Saigenji1 , N.  Kobayashi2 , H.  Mitomi3
  • 1Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
  • 2Department of Surgery, Kitasato University Hospital, Sagamihara, Japan
  • 3Department of Pathology, Sagamihara National Hospital, Sagamihara, Japan
Weitere Informationen

Publikationsverlauf

submitted 16 August 2006

accepted after revision 17 November 2006

Publikationsdatum:
25. Januar 2007 (online)

Background and study aims: Endoscopic mucosal resection (EMR) is a minimally invasive local treatment for superficial esophageal carcinoma (SEC). The use of EMR in patients with m3 or sm1 SEC remains controversial, however. The aim of this retrospective study was to evaluate the histopathological risk factors for lymph-node metastasis and recurrence in patients with m3 or sm1 SEC.

Patients and methods: The study subjects were 43 patients with m3 or sm1 esophageal squamous-cell carcinomas: 23 patients were treated surgically (the surgery group), and 20 were treated by EMR (the EMR group). We assessed the following variables of the specimens resected by surgery or EMR: tumor depth, maximal surface diameter of the tumor (superficial size), maximum diameter of tumor invasion at the lamina muscularis mucosae (LMM invasion width), and lymphatic invasion. The relationships of these variables to lymph-node metastasis and recurrence were examined.

Results: In the surgery group, lymph-node metastasis was found in four patients, all of whom had tumors with lymphatic invasion, a superficial size of at least 25 mm, and an LMM invasion width of at least 2500 μm. In the EMR group, no patient met all three of these criteria, and there was no evidence of lymph-node metastasis or distant metastasis on follow-up after EMR (median follow-up 39 months).

Conclusions: In patients with m3 or sm1 SEC, tumors that have lymphatic invasion, larger superficial size, and wider LMM invasion are associated with a high risk for lymph-node metastasis. EMR might be indicated for the treatment of patients with m3 or sm1 SECs without these characteristics.

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K. Higuchi, MD

Department of Gastroenterology, Kitasato University East Hospital

2-1-1 Asamizodai

Sagamihara

Kanagawa 228-8520, Japan

Fax: +81-42-749-8690

eMail: k.higu@kitasato-u.ac.jp