Abstract
ABSTRACTBackground: Knowing esophageal tumors behavior in relationship to lymph node involvement, distant metastases and local tumor invasion is of paramount importance for the best esophageal tumors management. Aim: To describe lymph node involvement, distant metastases, and local tumor invasion in esophageal carcinoma, according to tumor topography and histology. Methods: A total of 444 patients with esophageal squamous cell carcinoma and 105 adenocarcinoma were retrospectively analyzed. They were divided into four groups: adenocarcinoma and squamous cell carcinoma in the three esophageal segments: cervical, middle, and distal. They were compared based on their CT scans at the time of the diagnosis. Results: Nodal metastasis showed great relationship with of primary tumor site. Lymph nodes of hepatogastric, perigastric and peripancreatic ligaments were mainly affected in distal tumors. Periaortic, interaortocaval and portocaval nodes were more commonly found in distal squamous carcinoma; subcarinal, paratracheal and subaortic nodes in middle; neck chains were more affected in cervical squamous carcinoma. Adenocarcinoma had a higher frequency of peritoneal involvement (11.8%) and liver (24.5%) than squamous cell carcinoma. Considering the local tumor invasion, the more cranial neoplasia, more common squamous invasion of airways, reaching 64.7% in the incidence of cervical tumors. Middle esophageal tumors invade more often aorta (27.6%) and distal esophageal tumors, the pericardium and the right atrium (10.4%). Conclusion: Esophageal adenocarcinoma and squamous cell carcinoma in different topographies present peculiarities in lymph node involvement, distant metastasis and local tumor invasion. These differences must be taken into account in esophageal cancer patients' care.
Highlights
Esophageal carcinoma is disease with a high morbimortality rate, even after curative intent surgery1,3
The population studied was composed of 444 patients with squamous cell carcinoma of esophagus (SCC) and 105 patients with esophageal adenocarcinoma (EA)
Patients were subdivided into four groups: cervical SCC (15-20 cm from incisors); middle esophagus SCC; distal esophagus SCC; and adenocarcinoma of esophagus, based on the first upper GI endoscopy realized in each patient
Summary
Esophageal carcinoma is disease with a high morbimortality rate, even after curative intent surgery. Esophageal carcinoma is disease with a high morbimortality rate, even after curative intent surgery1,3 It turns more noticeable when diagnosis is late – which is quite usual, since more than half of patients is diagnosed in advance stages. Most of its complications are intrinsically associated to the natural history of the disease. Main local complications are associated to local tumor invasion in airway, leading to pulmonary infections or massive hemoptysis. Other complications, such as cholangitis or hepatic failure may be associated with distant disease involvement. Knowing esophageal tumors behavior, such as lymph-node involvement, distant
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