Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection
Esophagectomy for superficial esophageal cancer after non-curative endoscopic resection
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DOI：
10.1007/s00535-014-0983-6
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发表时间：
2015-04-01
影响因子：
6.3
通讯作者：
Sano, Takeshi
中科院分区：
文献类型：
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作者：
Saeki, Hiroshi;Watanabe, Masayuki;Sano, Takeshi
对于浅表性食管癌，应考虑在非治愈性内镜切除术后进行额外的手术治疗，除非经病理证实肿瘤属于内镜切除术的绝对适应症。然而，这种治疗策略的意义一直没有得到很好的评价，直到现在，额外的食管切除术和淋巴结清扫术，共34例食管癌患者病理诊断为接触或侵犯粘膜肌层（pT 1a-MM）或粘膜下层（pSM）和/或伴随血管渗透后内镜切除。分析手术结果、食管切除术后病理诊断和结局，内镜切除术后病理诊断为pT 1a-MM 7例，pSM 27例，血管渗透24例。食管切除术分别经右胸26例和左胸2例，经裂孔6例。12例行三野淋巴结清扫术，清扫淋巴结31-132个，平均72个。病理性淋巴结转移10例。10例患者发生术后并发症，1例患者因肺部并发症死亡。术后随访1-87个月，无复发，内镜下食管切除术对伴有pT 1a-MM/pSM和/或血管浸润的食管癌有良好的疾病控制作用，但由于其侵袭性，需要严格考虑手术适应证和手术方式。
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.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.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).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.