Treatment of Mucosal and Submucosal cancer in Esophagus -The Turning Point to Decide Whether Surgical Operation or endoscopic Surgery-

Hiroyasu Makuuchi, Takao Machimura, Kyoichi Mizutani, Hideo Shimada, Kohji Kanno, Osamu Chino, Yutaka Tokuda, Takashi Sugihara, Tetsuji Sasaki, Tomoo Tajima, Toshio Mitomi

Department of Surgery, School of Medicine, Tokai University

Early and superficial esophageal cancer has been increasing since 1986, and endoscopic mucosal resection for early esophageal cancer has been developed in Japan. The analysis of 99 patients with superficial cancer who underwent surgery in our institution revealed the following facts: none of ep to mm2 cancers had lymph vessel invasion or lymph node metastasis; 33.3% to 44.4% of mm3 to sm l cancers had lymph vessel invasion and 11.1% had lymph node metastasis; 66.7% to 88.9% of sm2 to sm3 cancers had lymph vessel invasion, and 25.0% to ,44.4% had lymph node metastasis. The 5-year survival rates of ep to sml cancers were both 100%, but those of sm2 and sm3 were 58.9% and 54.2%, respectively. The decision of whether to employ surgical operation or endoscopic surgery needs to be made in mm3 to sm1 cancer cases. Generally we choose radical surgical operation for these cases, because of the possibility of lymph node metastasis. But in patients who have poor operative risks and have no evidence of lymph node metastasis, we choose endoscopic surgery rather than surgical operation, because of the improved mortality and morbidity, and better quality of life after treatment.

Key words
treatment of superficial esophageal cancer, endoscopic surgery for early esophageal cancer, endoscopic mucosal resection for early esophageal cancer

Reprint requests
Hiroyasu Makuuchi Department of Surgery, School of Medicine, Tokai University
Boseidai, Isehara, 259-11 JAPAN

Accepted
June 14, 1993

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