Abstract
PurposeEndoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional treatment due to the possibility of lymph node metastasis. The aim of this study was to elucidate the clinical outcomes of these additional treatments.MethodsThe study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy and 31 received chemoradiotherapy (CRT).ResultsThe median follow-up periods were 45 months in the esophagectomy group and 41 months in the CRT group. The overall survival did not differ significantly between the groups (P = 0.46). However, there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence due to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, six patients; CRT group, ten patients), none in the esophagectomy group had recurrence, whereas four in the CRT group died of esophageal cancer (P = 0.031).ConclusionThe overall survival did not differ significantly between the groups. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion.
Highlights
Esophageal cancer is the sixth-most common cause of cancer-related mortality worldwide [1]
There were no significant differences in Anesthesiologists physical status (ASA PS) classification, comorbidities, or tumor location or size between the groups
CT1a cancer was the initial diagnosis for nine patients (32.1%) in the esophagectomy group; positive lymph node metastases were observed in the surgical specimens
Summary
Esophageal cancer is the sixth-most common cause of cancer-related mortality worldwide [1]. Most cases of esophageal carcinoma in Japan are squamous cell carcinoma (SCC) [2]. The etiology of esophageal SCC differs from that of adenocarcinoma. Alcohol consumption and smoking are risk factors for esophageal SCC, and in East Asia, many individuals have a flushing response after alcohol intake, which. A correlation exists between the rate of lymph node metastasis and the depth of tumor invasion of superficial esophageal cancer. The reported rates of lymph node metastasis are 0–4.0% for cancers in the epithelium (EP) and lamina propria mucosae (LPM), 0–15% in the muscularis mucosae (MM), and > 20% in the SM [6,7,8,9]. Yamashita et al [9] showed that the incidence of metastasis in mucosal cancer was associated with lymphovascular invasion and reported cumulative 5-year metastasis rates of 46.7 and 0.7%
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