Abstract
Background
Early squamous cell carcinoma (SCC) and early adenocarcinoma (AC) of the esophagus are potentially curable diseases. The crucial point in treatment is that the depth of tumor infiltration into the mucosal and submucosal layers is correlated with the rate of nodal metastases and therefore with long-term prognosis.
Methods and focus
In submucosal SCC with a high rate of nodal metastases curative resection can be achieved only by radical esophagectomy with systematic lymphadenectomy, which remains the treatment of choice for this tumor entity. In submucosal AC the Merendino procedure may offer an alternative since lymphatic invasion occurs at a later stage than in SCC, and locoregional lymph nodes can be adequately resected. Major advantages of this operation over radical esophagectomy include the complete resection of the entire Barrett segment and the lower postoperative morbidity and mortality. Vagal-sparing esophagectomy still lacks adequate oncological evaluation for it to be recommended except in stage I a tumors. For mucosal SCC and AC endoscopic mucosal resection is the treatment of choice but requires intensive follow-up since the rate of complete resections is lower than in limited and radical surgical procedures. On the other hand, a low postoperative morbidity and the functional integrity of the tubular esophagus support the use of endoscopic mucosal resection for mucosal cancer.
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References
Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind C (1998) UICC TNM Classification of malignant tumors, 4th edn. Springer, Berlin Heidelberg New York, pp 71–80
Hölscher AH, Bollschweiler E, Bumm R, Bartels H, Siewert JR (1995) Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 118:845–855
Hulscher JBF, Tijssen JGP, Obertop H, van Lanschot JJB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a metaanalysis. Ann Thorac Surg 72:306–313
Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–403
Hölscher AH, Bollschweiler E, Schneider PM, Siewert JR (1995) Prognosis of early esophageal cancer. Cancer 76:178–186
Sanohe Y, Hiratsuka R, Doki K (1981) Lymph node metastases in cancer of the thoracic esophagus. Am J Surg 141:216–218
Nishimaki T, Tanaka O, Suzuku T, Aizawa K, Hatakeyama K, Muto T (1994) Pattern of lymphatic spread in thoracic esophageal cancer. Cancer 74:4–11
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M (2000) Improvement in the results of surgical treatment of advanced squamous eesophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232
Schröder W, Baldus SE, Mönig SP, Zirbes TK, Beckurts KTE, Hölscher AH (2001) Lesser curvature lymph node metastases with esophageal squamous cell carcinoma: implications for gastroplasty. World J Surg 25:1125–1128
Igaki H, Kato H, Tachimori Y, Nakanishi Y (2000) Cervical lymph node metastasis in patients with submucosal carcinoma of the thoracic esophagus. J Surg Oncol 75:37–41
Matsubara T, Ueda M, Kaisaki S, Kurodo J, Uchida C, Kokudo N, Takahashi T, Nakajima T, Yanagisawa A (2000) Localization of initial lymph node metastasis from carcinoma of the thoracic esophagus. Cancer 89:1869–1873
Dresner SM, Lamb PJ, Bennet MK, Hayes N, Griffin SM (2001) The pattern of metastatic lymph node dissemination from adenocarcinoma of the esophagogastric junction. Surgery 129:103–109
Hulscher JBF, van Sandick JW, Offerhaus GJH, Tilanus HW, Obertop H, van Lanschot JJB (2001) Prospective analysis of the diagnostic yield of extended en bloc resection for adenocarcinoma of the oesophagus or gastric cardia. Br J Surg 88:715–719
Schröder W, Mönig SP, Baldus SE, Gutschow C, Schneider PM, Hölscher AH (2002) Frequency of nodal metastases to the upper mediastinum in Barrett's cancer. Ann Surg Oncol 9:807–811
Altorki NK, Kent M, Ferrara C, Port J (2002) Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg 236:177–183
Endo M, Yoshino K, Kawano T, Yano K (1993) Clinical evaluation of mucosal cancer of the esophagus: analysis of 1584 cases of superficial esophageal cancer resected in Japan. In: Nabeya K, Hanaoka T, Nogami H (eds) Recent advances in diseases of the esophagus. Springer, Berlin Heidelberg New York, pp 540–545
Nabeya K (1993) Early carcinoma of the esophagus. In: Nabeya K, Hanaoka T, Nogami H (eds) Recent advances in diseases of the esophagus. Springer, Berlin Berlin New York, pp 374–380
Hölscher AH, Bollschweiler E, Schneider PM, Siewert JR (1997) Early adenocarcinoma in Barrett's oesophagus. Br J Surg 84:1470–1473
Hölscher AH, Bollschweiler E, Schröder W, Gutschow C, Siewert J (1997) Prognostic differences between early squamous-cell and adenocarcinoma of the esophagus. Dis Esophagus 10:179–184
Siewert JR, Stein HJ, Feith M, Brücher B, Bartels H, Fink U (2001) Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1,000 consecutive resections at a single center in the western world. Ann Surg 234:360–369
Gossner L, May A, Stolte M, et al (1999) KTP laser desctruction of dysplasia and early cancer in columnar-lined Barrett's esophagus. Gastrointest Endosc 49:8–12
Sharma P, Jaffe PE, Bhattacharyya A, Sampliner RE (1999) Laser and multipolar electrocoagulation ablation of early Barrett's adenocarcinoma: longterm follow up. Gastrointest Endosc 49:442–446
Nishi M, Omori Y, Miwa K (1995) Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma. Kanehara, Tokyo
Ell C, May A, Gossner L, Pech O, Günter E, Mayer G, Henrich R, Vieth M, Müller H, Seitz G, Stolte M (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterology 118:670–677
May A, Gossner L, Pech O, Müller H, Vieth H, Stolte M, Ell C (2002) Intraepithelial high grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques. Endoscopy 34:604–610
Wolfsen HC, Woodward TA, Raimondo M (2002) Photodynamic therapy for dysplastic Barrett esophagus and early esophageal adenocarcinoma. Mayo Clin Proc 77:1176–1181
Gossner L, May A, Sroka R, Stolte M, Hahn EG, Ell C (1999) Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after the oral administration of 5–aminolevulinic acid. Cancer 86:1921–1928
Gossner L, Stolte M, Sroka R, Rick K, May A, Hahn EG, Ell C (1998) Photodynamic ablation of highgrade dysplasia and early cancer in Barrett's esophagus by means of 5–aminolevulinic acid. Gastroenterology 114:448–455
Barr H, Shepherd NA, Dix A, Roberts DJ, Tan WC, Krasner N (1996) Eradication of high-grade dysplasia in columnar-lined (Barrett's) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX. Lancet 348:584–585
Panjehpour M, Overholt BF, Haydek JM, Lee SG (2000) Results of photodynamic therapy for ablation of dysplasia and early cancer in Barrett's esophagus and effect of oral steroids on stricture formation. Am J Gastroenterol 95:2177–2184
Wang KK (2000) Photodynamic therapy of Barrett's esophagus. Gastrointest Endosc Clin N Am 10:409–419
Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejuncal segment for anatomic and physiological abnormalities at the esophagogastric junction. Ann Surg 142:486–506
Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett's esophagus. Ann Surg 232:733–742
Siewert JR, Hölscher AH (1997) Jejunal interposition in esophageal replacement. In: Nyhus LM, Baker RJ, Fischer JE (eds). Mastery of surgery, 3rd edn, vol I. Little Brown, Boston, pp 802–812
Akiyama H, Tsurumaru M, Ono Y (1994) Esophagectomy without thoracotomy with vagal preservation. J Am Coll Surg 178:83–85
Banki F, Mason RJ, DeMeester SR, Hagen JA, Balaji NS, Crookes PF, Bremner CG, Peters JH, DeMeester TR (2002) Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg 236:324–336
Fujita H, Sueyoshi S, Yamana H, Shinozaki K (2001) Optimum treatment strategy for superficcial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy. World J Surg 25:424–431
Schröder W, Baldus SE, Mönig SP, Beckurts KTE, Dienes HP, Hölscher AH (2002) Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg 26:584–587
Fujisaki J (1993) Endosonographic diagnosis of the depth of early gastric carcinoma with a sonoprobe system (20 MHz). Endosc Dig 5:157
Kurihara N (1995) The usefulness of a 20 MHz sonoprobe for selection of surgical treatment for early gastric cancer. Prog Dig Endosc 47:69–72
Kodama M, Kakegawa T (1998) Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery 123:432–439
Hölscher AH, Becker K, Höfler H, Fink U, Siewert JR (1996) Plattenepithel-Frühcarcinom des Oesophagus-Multizentrizität, Metastasierungsmuster und Prognose. Chirurg 67:357–361
Hölscher AH, Siewert JR (1997) Surgical treatment of early esophageal cancer. Dig Surg 14:70–76
Nishimaki T, Suzuki T, Kanda T, Obinata T, Komukai S, Hatakeyama K (1999) Extended radical esophagectomy for superficially invasive carcinoma of the esophagus. Surgery 125:142–147
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Schröder, W., Gutschow, C.A. & Hölscher, A.H. Limited resection for early esophageal cancer?. Langenbecks Arch Surg 388, 88–94 (2003). https://doi.org/10.1007/s00423-003-0371-9
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DOI: https://doi.org/10.1007/s00423-003-0371-9