Abstract
We performed a clinical pathological study of conventionally resected superficial esophageal carcinomas since this type of lesion has been increasing, in order to develop criteria of determination for therapeutic strategies. Pathological studies were performed on specimens obtained by radical surgical resection in 133 cases of superficial esophageal cancer. Evaluation was performed in terms of the gross classification of the lesion type, depth of invasion, lymph node metastasis, vascular invasion, size of the lesion, outcome, etc. In 0-I, 0-IIc+0-IIa, and 0-III type submucosal cancer lesions the rate of metastasis to lymph nodes was more than 40%, but in 0-IIa and 0-IIb mucosal cancer cases no lymph node metastasis was observed. 0-IIc type lesions showed a wide range of invasiveness, ranging from m1 to sm3. In cases with m1 or m2 invasion, no lymph node or lymph-vessel invasion was recognized, but in m3, sm1, sm2, and sm3 cases lymph node metastasis was recognized in 12.5%, 22.2%, 44.0% and 47.4%, respectively. In 47% of lesions with a greatest dimension of less than 30 mm invasion was limited to the mucosa. Seventy-two percent of m1 and m2 cases were 30 mm in size or less. Lymph node metastasis was recognized in only 16.7% of cases less than 30 mm in size, but in cases of lesions 30 mm or more the rate of lymph node metastasis was 35.8%. 0-IIb and 0-IIa type lesions are indications for endoscopic esophageal mucosal resection (EEMR), while 0-I, 0-IIc+0-IIa, and 0-III lesions should be candidates for radical surgical resection. In the 0-IIc category, lesions in which the depression is relatively flat and with a finely granular surface are indications for EEMR, but those cases in which the surface of depression shows granules of varying sizes should be treated with radical surgical resection. Cases of 0-IIa type 30 mm or larger in greatest dimension which have a gently sloping protruding margin shoulder or reddening should be treated with caution, but EEMR can be performed first and subsequent therapeutic strategy decided on, based on the pathological findings of the specimen.
Highlights
MATERIALS AND METHODSIncreasing numbers of superficial esophageal cancer lesions are being detected due to the applications of dye staining methodologies [1,2] and other improvements in endoscopic diagnosis
The total number of esophageal cancer cases treated at our institution through December 1995, totaled 957, of which 28% were superficial esophageal cancers limited to within the mucosal or submucosal layers The increase in the detected numbers of superficial esophageal cancer lesions became most notable from around 1986, which coincided with the increasing use of direct view panendoscopy
Submucosal cancers predominated amongst this group, but the increasing use of the iodine dye staining technique from around 1990 resulted in an increase in the number of mucosal cancerr With the rapid increase in the number of cases, various types of new therapeutic methods such as endoscopic esophageal mucosal resection (EEMR) [3,4] appeared, and it is becoming increasingly important to develop criteria for the indications of such therapeutic strategies based on thorough clinical pathological analysis of superficial esophageal cancer
Summary
MATERIALS AND METHODSIncreasing numbers of superficial esophageal cancer lesions are being detected due to the applications of dye staining methodologies [1,2] and other improvements in endoscopic diagnosis. We analyzed the clinical pathological feature and outcome of cases of superficial esophageal cancer that had been treated by conventional surgical resection and lymph node dissection at our institution. Clinical pathological studies were performed to determine the gross classification, size of the lesion, depth of the lesion, lymph node metastasis, vascular invasion, multiple primary lesions in the same esophagus, multiple primary cancers of other organs, and outcome based on the Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus of the Japan Society of Esophageal Diseases [5].
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