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Transthoracic Esophagectomy After Endoscopic Mucosal Resection in Patients with Early Esophageal Carcinoma

Journal of Gastrointestinal Surgery volume 13, pages 223–229 (2009)Cite this article

Abstract

Introduction

For patients with esophageal carcinoma limited to the mucosa endoscopic mucosal resection (EMR) is the therapy of choice whereas surgical resection is advocated for submucosal tumors.

Methods

This study analyzes the histopathologic results of patients with early esophageal carcinoma who underwent EMR prior to transthoracic esophagectomy. Sixteen patients with early esophageal carcinoma and EMR as first line treatment were included in this retrospective study. Ten patients underwent transthoracic esophagectomy because of submucosal infiltration combined incomplete tumor resection at the lateral/basal resection margin. In one patient each, surgical therapy was indicated due to submucosal infiltration or incomplete resection only. Three patients underwent surgical resection due to residual neoplasia within an esophageal stenosis following EMR. Surgical specimens were examined for pT and pN stage according to the UICC.

Results

Three patients had a squamous cell carcinoma (SCC) and 13 patients an adenocarcinoma (AC), nine patients with a long segment Barrett’s esophagus. The distribution of the pT stages was as follows: 6× pT0 (no histopathologic evidence of residual tumor), 1× pT1m1, 1× pT1m2, 3× pT1m3, 1× pT1sm1, 1× pT1sm2, 1× pT2, and 2× pT3. Three of 16 patients (18.8%) with a pT1sm1, pT2, and pT3 stage had nodal metastases. In all three patients metastatic nodes were located in the mediastinum. In two patients, a second carcinoma was detected during histopathologic work-up (1× AC in the cardia and 1× SCC in the cervical esophagus).

Conclusion

The data of this highly selected patients indicate that the boundary between the therapy of mucosal and submucosal tumors is not as clear as stated. Therefore, treatment of early esophageal carcinoma demands a close interdisciplinary cooperation.

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References

  1. Ell C, May A, Pech O, et al. Curative endoscopic resection of early adenocarinomas (Barrett’s cancer). Gastrointest Endosc 2007;65:3–10. doi:10.1016/j.gie.2006.04.033.

    PubMed  Article  Google Scholar 

  2. Pech O, Gossner L, May A, et al. Endoscopic resection of superficial esophageal squamous cell carcinomas: Western experience. Am J Gastroenterol 2004;99:1226–232. doi:10.1111/j.1572-0241.2004.30628.x.

    PubMed  Article  Google Scholar 

  3. Hölscher AH, Bollschweiler E, Schneider PM, et al. Early adenocarcinoma in Barrett’s esophagus. Br J Surg 1997;84:1470–1473. doi:10.1002/bjs.1800841035.

    PubMed  Article  Google Scholar 

  4. Bollschweiler E, Baldus E, Schröder W, et al. High rate of lymph node metastasis in submucosal esophageal squmous cell carcinomas and adenocarcinomas. Endoscopy 2006;38:149–156. doi:10.1055/s-2006-924993.

    PubMed  Article  CAS  Google Scholar 

  5. Hölscher AH. Endoscopic mucosal resection for early squamous-cell cancer of the esophagus—a dangerous game or standard treatment. Endoscopy 2007;39:77–79. doi:10.1055/s-2007-966149.

    PubMed  Article  Google Scholar 

  6. Westerterp M, Koppert L, Buskens C, et al. Outcome of surgical treatment of early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 2005;446:497–504. doi:10.1007/s00428-005-1243-1.

    PubMed  Article  Google Scholar 

  7. May A, Günter E, Roth F, et al. Accuracy of staging in early oesophageal cancer using high resolution endosonography: a comparative, prospective, and blinded study. Gut 2004;53:634–640. doi:10.1136/gut.2003.029421.

    PubMed  Article  CAS  Google Scholar 

  8. Vieth M, Ell C, Gossner L, et al. Histological analysis of endoscopic resection specimens from 326 patients with Barrett’s esophagus and early neoplasia. Endoscopy 2004;36:776–781. doi:10.1055/s-2004-825802.

    PubMed  Article  CAS  Google Scholar 

  9. Igaki H, Tachimori Y, Kato H. Imroved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg 2004;239:483–490. doi:10.1097/01.sla.0000118562.97742.29.

    PubMed  Article  Google Scholar 

  10. Law S, Wong KH, Kwok KF, et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004;239:22–27. doi:10.1097/01.sla.0000103381.32956.7c.

    Article  Google Scholar 

  11. Mariette C, Taillier G, Van SI, et al. Factors affecting postoperative course and survival after en-bloc resection for esophageal carcinoma. Ann Thorac Surg 2004;78:1177–1183. doi:10.1016/j.athoracsur.2004.02.068.

    PubMed  Article  Google Scholar 

  12. Lambert R, Lightdale CJ. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. GI Endosc 2003;58(Suppl 6):S3–27.

    Google Scholar 

  13. Inoue H. Endoscopic mucosal resection for esophageal and gastric mucosal cancers. Can J Gastroenterol. 1998;12:355–359.

    PubMed  CAS  Google Scholar 

  14. Hölscher AH, Schneider PM, Gutschow C, et al. Laparoscopic ischemic conditioning of the stomach for esohageal replacement. Ann Surg 2007;245:241–246. doi:10.1097/01.sla.0000245847.40779.10.

    PubMed  Article  Google Scholar 

  15. Hölscher AH, Schröder W, Bollschweiler E, et al. How safe is high intrathoracic esophagogastrostomy? Chirurg 2003;74:726–733. doi:10.1007/s00104-003-0649-z.

    PubMed  Article  Google Scholar 

  16. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma; 2nd English edition. Gastric Cancer 1998;1:10–24.

    PubMed  Article  Google Scholar 

  17. Japanese Society for Esophageal Diseases. Guidelines for the clinical and pathological studies on carcinoma of the esophagus. Jpn J Surg 1976;6:69–76. doi:10.1007/BF02468889.

    PubMed  Article  CAS  Google Scholar 

  18. Schröder W, Bollschweiler E, Kossow C, et al. Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy? Langenbecks Arch Surg 2006;391:455–460. doi:10.1007/s00423-006-0067-z.

    PubMed  Article  Google Scholar 

  19. Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 2002;49:534–539. doi:10.1136/gut.49.4.534.

    Article  Google Scholar 

  20. Buskens CJ, Westerterp M, Lagarde SM, et al. Prediction of appropriateness of local endoscopic treatment for high grade dysplasia and early adenocarcinoma by EUS and histopathological features. Gastrointest Endosc 2004;60:703–710. doi:10.1016/S0016-5107(04)02017-6.

    PubMed  Article  Google Scholar 

  21. Hull MJ, Mino-Kenudson M, Nishioka NS, et al. Endoscopic mucosal resection. An improved diagnostic procedure for early gastroesophageal epithelial neoplasms. Am J Surg Pathol 2006;30:114–118. doi:10.1097/01.pas.0000180438.56528.a0.

    PubMed  Article  Google Scholar 

  22. Endo M, Yoshino K, Kawano T, et al. Clinocopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus 2000;13:125–129. doi:10.1046/j.1442-2050.2000.00100.x.

    PubMed  Article  CAS  Google Scholar 

  23. Mönig SP, Zirbes TK, Schröder W, et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. AJR 1999;173:365–367.

    PubMed  Google Scholar 

  24. Schröder W, Baldus S, Mönig S, et al. Lymph node staging of esophageal carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg 2002;26:584–587. doi:10.1007/s00268-001-0271-5.

    PubMed  Article  Google Scholar 

  25. Schröder W, Mönig S, Baldus S, et al. Frequency of nodal metastases to the upper mediastinum in Barrett’s cancer. Ann Surg Oncol 2002;9:807–811.

    PubMed  Google Scholar 

  26. Hölscher AH, Bollschweiler E, Schneider PM, et al. Prognosis of early esophageal cancer: comparison between adeno- and squamous cell carcinoma. Cancer 1995;76:178–186. doi:10.1002/1097-0142(19950715)76:2<178::AID-CNCR2820760204>3.0.CO;2-D.

    PubMed  Article  Google Scholar 

  27. Stein HJ, Feith M, Mueller J, et al. Limited resection of early adenocarcinoma in Barrett’s esohagus. Ann Surg 2000;232:733–742. doi:10.1097/00000658-200012000-00002.

    PubMed  Article  CAS  Google Scholar 

  28. Tachibana M, Kinugasa S, Shibakita M, et al. Surgical treatment of superficial esophageal cancer. Langenbecks Arch Surg 2006;391:304–321. doi:10.1007/s00423-006-0063-3.

    PubMed  Article  Google Scholar 

  29. Lerut T, Nafteux P, Moons J, et al. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections. Ann Surg 2004;240:962–972. doi:10.1097/01.sla.0000145925.70409.d7.

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of Visceral and Vascular Surgery, University of Cologne, Kerperner Str. 62, 50937, Cologne, Germany

    W. Schröder, C. Gutschow, D. Vallböhmer, M. Bludau & A. H. Hölscher

  2. Department of Gastroenterology, Evangelisches Krankenhaus Duesseldorf, Duesseldorf, Germany

    K. Wirths, B. Schumacher & H. Neuhaus

Authors
  1. W. Schröder
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  2. K. Wirths
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  3. C. Gutschow
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  4. D. Vallböhmer
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  5. M. Bludau
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  6. B. Schumacher
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  7. H. Neuhaus
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  8. A. H. Hölscher
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Correspondence to W. Schröder.

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Schröder, W., Wirths, K., Gutschow, C. et al. Transthoracic Esophagectomy After Endoscopic Mucosal Resection in Patients with Early Esophageal Carcinoma. J Gastrointest Surg 13, 223–229 (2009). https://doi.org/10.1007/s11605-008-0719-0

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  • DOI: https://doi.org/10.1007/s11605-008-0719-0

Keywords

  • Endoscopic mucosal resection
  • Esophagectomy
  • Early esophageal carcinoma