The Therapeutic Strategy of Submucosal Esophageal Cancer by Clinicophathological Findings and Lymph Node Metastasis

Masashi Takemura, Harushi Osugi, Nobuyasu Takada, Satoru Kishida, Masahiro Nishikawa, Eiki Okuda, Masakatsu Ueno, Yoshinori Tanaka, Kennichirou Fukuhara and Hiroaki Kinoshita

Second Department of Surgery, Osaka City University Medical School

We studied the therapeutic strategy in submucosal esophageal cancer using clinicopathological factors and metastasized node size. Patients and Methods: 50 patients with pT1b esophageal cancer undergoing 3-field lymph node dissection were evaluated. Results: Of the 50 patients, lymph node metastasis was found in 18. Clinicopathologically, the incidence of well differentiated squamous cell carcinoma, negative lymphatic or blood vessel invasion was higher in the 32 patients without lymph node metastasis than the 18 with. In multivariant analysis, the negative lymphatic or blood vessel invasion was the most affecting factor for contributing to lymph node metastasis. Of the 2532 nodes dissected, the number of metastasized nodes was 63, including 41 with a mojor axis of 10mm or shorter and 19 with a major axis of 6mm or shorter in length. Macroscopic diagnosis of metastasis was difficult in nodes less than 9mm in diameter. Survival was 84%5 years after surgery and 5 patients died of cancer recurrence 3 hematogenous and 2 lymphatic. Those with lymphatic invasion showed significantly poorer prognosis than others. Conclusions: For the patients with pT1b esophageal cancer who can indicate endoscopic mucosal resection, the diagnostic mucosal resection was selected first. If the lesion was well differentiated squamous cell carcinoma and had no lymphatic or blood vessel invasion, the possibility of lymph node metastasis was low. But, the 3-field lymph node dissection was required in the other patients

Key words
submucosal esophageal cancer, endoscopic mucosal resection, lymph node metastasis

Reprint requests
Masashi Takemura Second Department of Surgery, Osaka City University Medical School 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8586 JAPAN

Accepted
September 19, 2001

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