Diagnosis and Treatment for Mucosal Carcinoma of the Esophagus -With Special Reference to the Indication for Endoscopic Mucosal Resection-

Shigeyuki Tamura, Hitoshi Shiozaki, Masatomo Inoue, Hiroshi Oka, Yuichiro Doki, Takatoshi Kadowaki, Shigeo Matsui, Suguru Iwazawa, Kaoru Shimaya, Toshimasa Tsujinaka, Yoshihiro Kido, Takesada Mori

Department of Surgery II, Osaka University Medical School

For the purpose of finding an appropriate treatment for mucosal carcinoma of the esophagus, we reviewed the macroscopic and microscopic findings of 17 cases (25 lesions) of mucosal cancer, 6 cases of sm1 cancer and 8 cases of sm2 or sm3 cancer, of less than 2 cm in diameter. Mucosal cases had no lymph node metastasis, while 50% of sml cases had lymph node metastasis. In 7 cases of mm3, vascular invasion was found in two cases with a diameter of more than 2 cm. Macroscopically, all lesions of mucosal carcinoma consisted of the 0-II type. Although 0-IIa lesions showed invasion of more than mm2, the elevated area of mucosal lesions was smaller than 1.3 cm in size and lower than 1 mm in height. On the other hand, 5 of 6 sml cases had protruding lesions, the mean size of which was 2.7 cm. Moreover, of 8 cases that showed invasion of the sm2 or sm3 layer and diameter of less than 2 cm, 5 cases involved 0-I type lesions and 2 had O-III type lesions, and these cases were easy to differentiate from mucosal lesions. Only one case of 0-II type seemed indistinguishable from mucosal lesions. This study demonstrated that endoscopic mucosal resection could be indicated in cases with flat and/or slightly depressed lesions and in cases (if they have protruding lesions) of less than 2 cm in diameter and less than 1 mm in height. Cases with other gross features were thought to require esophagectomy with lymph node dissection.

Key words
mucosal carcinoma of esophagus, estimation of the depth of invasion in mucosal esophageal cancer, gross features of mucosal carcinoma of esophagus, treatment for mucosal carcinoma of esophagus, endoscopic mucosal resection

Reprint requests
Shigeyuki Tamura Department of Surgery II, Osaka University Medical School
2-2 Yamadaoka, Suita City, 565 JAPAN

Accepted
January 12, 1994

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