Decision on Operative Method for Esophageal Carcinoma According to the Preoperative Diagnosis

Teruo Kouzu, Yoshio Koide, Miwako Arima, Etsuo Hishikawa, Ikuya Oshima, Noriyuki Tonosu, Toshiyuki Kikuchi, Kaichi Isono

Second Department of Surgery, Chiba University

In recent years, early esophageal cancer has become a target for endoscopic treatment, and resection of the cancer in aged patients is increasing, Under these circumstance, preoperative diagnosis is expected to be almost 100% accurate, especially in regard to the depth of cancer invasion and the extent of lymph node metastasis, in order to decide on the operative method. Diagnosis of the depth of cancer invasion has become 82.7% in accuracy by using a new endoscopic classification for superficial esophageal cencer. Endoscopic ultrasonography (EUS) is the best examination at present as to lymph node metastasis. According to the preoperative information from EUS, an endoscopic mucosectomy is performed for a small lesion of ep-mm1 cancer, and laser photodynamic therapy or surgical blunt descetion is selected for a spreading lesion. Esophagectomy by thoracotomy is required for mm2-sm1 cancers, and when blunt desection is selected radiotherapy must be added for a swelled lymph node detected preoperatively. For sm2-a2 cancers, usual thorachotomical esophagectomy and extended lymph node descetion should be performed. For a3 cancers, when invasion to the surrounding organs is limited esophagectomy should be tried as far as possible. However when the invaded area is relatively widespread a radical operation should be resingned and a by-pass operation should be conducted or an indwelling tube inserted to improve the quality of life for the patients.

Key words
endoscopic ultrasonography, esophageal carcinoma, lymph node metastasis, depth of cancer invasion

Reprint requests
Teruo Kouzu Second Department of Surgery, Chiba University
1-8-1 Inohana, Chiba, 280 JAPAN

Accepted
November 20, 1991

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