Optimum treatment strategy for superficial esophageal cancer: Endoscopic mucosal resection versus radical esophagectomy
Optimum treatment strategy for superficial esophageal cancer: Endoscopic mucosal resection versus radical esophagectomy
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DOI：
10.1007/s002680020053
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发表时间：
2001-04-01
影响因子：
2.6
通讯作者：
Inutsuka, H
中科院分区：
文献类型：
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作者：
Fujita, H;Sueyoshi, S;Inutsuka, H
本研究旨在确定涉及食管粘膜或粘膜下层的浅表食管癌的最佳治疗方法。受试者为150例浅表性食管癌患者，这些患者于1981年至1997年在库尔斯克大学医院接受了内镜粘膜切除术（EMR）或食管切除术。回顾性比较了（1）35例接受EMR的患者和37例接受食管切除术治疗粘膜食管癌的患者以及（2）45例接受扩大根治性食管切除术的患者和33例接受较少根治性食管切除术治疗粘膜下食管癌的患者的死亡率和发病率、生存率和复发率。在72例粘膜癌患者中，仅1例（1%）观察到淋巴结转移/复发;而在78例粘膜下癌患者中，30例（38%）观察到淋巴结转移/复发。在粘膜癌患者中，EMR后的死亡率和发病率低于食管切除术后的死亡率和发病率。EMR术后生存率与食管切除术相同。两种治疗方式后均未观察到复发。在粘膜下癌患者中，扩大根治性食管切除术后的生存率较高，复发率较低;扩大根治性食管切除术后的死亡率和发病率与非根治性食管切除术后相同。多变量分析表明，治疗方式（EMR与食管切除术）不影响粘膜食管癌患者的生存率，而它强烈影响粘膜下食管癌患者的生存率。我们的结论是EMR是粘膜食管癌的主要治疗方法，而扩大根治性食管切除术是粘膜下食管癌的主要治疗方法。
This study was designed to determine the optimum treatment for a superficial esophageal cancer involving the mucosal or suhmucosal layer of the esophagus. The subjects were 150 patients with a superficial esophageal cancer who underwent endoscopic mucosal resection (EMR) or esophagectomy in Kurume University Hospital from 1981 to 1997. The mortality and morbidity rates, survival rate, and recurrence rate were retrospectively compared for (1) 35 patients who underwent EMR and 37 patients who underwent esophagectomy for a mucosal esophageal cancer and (2) 45 patients who underwent extended radical esophagectomy and 33 patients who underwent less radical esophagectomy for a submucosal esophageal cancer. Among the 72 patients with a mucosal cancer, lymph node metastasis/recurrence was observed in only one (1%); whereas of 78 patients with a suhmucosal cancer it was observed in 30(38%). Among patients with a mucosal cancer the mortality and morbidity rates after EMR were lower than for those after esophagectomy. The survival rate after EMR was the same as that after esophagectomy. No recurrence was observed after either treatment modality. Among the patients with a submucosal cancer, the survival rate was higher and the recurrence rate lower after extended radical esophagectomy; than after less radical esophagectomy the mortality and morbidity rates after extended radical esophagectomy were the same as those after less radical esophagectomy. Multivariate analysis demonstrated that the treatment modality (EMR versus esophagectomy) did not influence the survival of patients with a mucosal esophageal cancer, whereas it strongly influenced the survival of patients with a suhmucosal esophageal cancer. We concluded that EMR was the mainstay; of treatment for a mucosal esophageal cancer, and extended radical esophagectomy was the mainstay of treatment for a submucosal esophageal cancer.