Indications and Results of Endoscopic Mucosectomy for Intraepithelial and Mucosal Cancer of the Esophagus

Kumiko Momma, Misao Yoshida*

Departments of Internal Medicine and Surger^*, Tokyo Metropolitan Komagome Hospital

We developed an endoscopic mucosectomy technique for removal of the mucosa and the submucosa of the esophagus. Indications for endoscopic mucosectomy for treatment of superficial esophageal cancer were studied by clinical and pathological analysis of patients with superficial esophageal cancer who had undergone radical esophagectomy at our hospital. Results of endoscopic mucosectomy in mucosal cancer cases were studies, and conditions for endoscopic decision for radical treatment of mucosal cancer of the esophagus were discussed. Indications for endoscopic mucosectomy: The incidence of lymph node metastasis that determined the prognosis of superfical esophageal cancer showed a close relation to the depth of cancer invasion into the esophageal wall. Lymph node metastasis was found in only 5.5% of patients with intraepithelial and mucosal cancer and they had an excellent outcome (the 5-year-survival rate was 100%). On the other hand, patients with submucosal cancer showed frequent lymph node metastasis (49%) and recurrence (the 5-year-survival rate was 50%). It was suggested that patients with intraepithelial and most of them with mucosal cancer could be treated by endoscopic mucosectomy technique. It was suggested that patients with typical 0-II lesions probably have no lymph node metastasis, for almost 95% of their tumors were reported as intraepithelial or mucosal cancer of the esophagus. Results of endoscopic mucosectomy: Endoscopic mucosectomy was carried out on 12 patients with intraepithelial cancer (7 cases), mucosal cancer (3) and severe atypical epithelial changes (2). Mode of resection: A single session could remove the whole lesion in 9 cases. Mucosectomy sessions were repeated in 3 cases. The largest dimension of removed specimen was 15 mm. Any mucosal lesion with dimensions over 10 mm was probably removed by dividing it into several pieces. Only one resection achieved complete removal of the lesion in 2 cases, several resections were required in 10 cases. Histological evaluation of resected specimens: All resected specimens contained the mucosa and submucosa. Histological studies revealed intraepithelial cancer in 7 cases, mucosal cancer in 3, atypical epithelium in 1 and only regenerative esophageal epithelial in 1 case although the biopsy specimen showed intraepithelial cancer before the endoscopic mucosectomy. Depth of removal was sufficient in all specimens. Histological evaluation of the margin of resection was difficult in cases in which the specimen was divided into several pieces. Complete removal by endoscopic mucosectomy: Complete removal of any mucosal lesion of the esophagus could be decided by endoscopic findings: The whole lesion should be removed in a single session. The margin of the resection should contain the normal mucosa. Iodine staining facilitates delineating the border of the lesion. No mucosal island should be left in the resection field. There was no relapse in patients with complete resection, but there was one relapse among three patients with incomplete resection. In one patient who underwent esophagectomy, histological studies revealed an intraepithelial cancer in the resected specimen. Complications of the mucosectomy: There were no major complications. In one patient there was a small amount of bleeding from the ulcer after the resection that could be controlled promptly by conservative treatment. Conclusions: Twelve patients with intraepithelial and mucosal cancer were treated by endoscopic mucosectomy. Relapse of the cancer was avoided by complete removal of the lesion. The whole lesion should be removed in one session and iodine staining facilitates this. Mucosal cancers with lymph node metastasis are rare, but their precise evaluation is not sufficient at present. Endoscopic mucosectomy for esophageal cancer is indicated for intraepithelial cancer and intraepithelial cancer with minimal invasion into the mucosa.

Key words
endoscopic mucosectomy, intraepithelial cancer, mucosal cancer

Reprint requests
Kumiko Momma Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
July 3, 1991

To read the PDF file you will need Abobe Reader installed on your computer.