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Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection

  • Original Article—Alimentary Tract
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Abstract

Background

Additional surgical treatment after non-curative endoscopic resection for superficial esophageal cancer should be considered unless the tumor is pathologically proven to be categorized within the absolute indication of endoscopic resection. However, the significance of this treatment strategy has been poorly evaluated until now.

Methods

Additional esophagectomy with lymph node dissection was carried out for a total of 34 patients with esophageal cancer pathologically diagnosed as in contact with or invading the muscularis mucosa (pT1a-MM) or submucosa (pSM) and/or accompanying vascular permeation after endoscopic resection. The surgical results, pathological diagnosis after esophagectomy, and outcomes were analyzed.

Results

The pathological diagnosis after endoscopic resection revealed pT1a-MM in 7 patients, pSM in 27 patients, and vessel permeation in 24 patients. The approach to esophagectomy was via right and left thoracotomy in 26 patients and 2 patients, respectively, and was transhiatal in 6 patients. Three-field lymph node dissection was performed in 12 patients, and the mean number of dissected lymph nodes was 72 (range 31–132). Pathological lymph node metastasis was noted in 10 patients. Postoperative complications developed in 10 patients, and death due to pulmonary complications was observed in one patient. No postoperative recurrence was observed during the follow-up period (1–87 months).

Conclusions

Esophagectomy after endoscopic resection provides favorable disease control for esophageal cancer with pT1a-MM/pSM and/or vessel permeation, while strict consideration is required to determine the indication and procedure for surgery because of its invasiveness.

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Fig. 1

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Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection,

MM:

Muscularis mucosa

SM:

Submucosa

LPM:

Lamina propria mucosae

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Acknowledgments

We thank Akio Nagaoka for assisting with the preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Hiroshi Saeki, Masayuki Watanabe, Shinji Mine, Hironobu Shigaki, Shuichiro Oya, Akiyoshi Ishiyama, Tomohiro Tsuchida, Junko Fujisaki & Takeshi Sano

  2. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Hideo Baba

  3. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hiroshi Saeki & Yoshihiko Maehara

Authors
  1. Hiroshi Saeki
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  2. Masayuki Watanabe
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  3. Shinji Mine
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  4. Hironobu Shigaki
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  11. Takeshi Sano
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Correspondence to Masayuki Watanabe.

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Saeki, H., Watanabe, M., Mine, S. et al. Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection. J Gastroenterol 50, 406–413 (2015). https://doi.org/10.1007/s00535-014-0983-6

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  • DOI: https://doi.org/10.1007/s00535-014-0983-6

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