Prognostic factors and Survival in Surgically Resected Superficial Esophageal Cancer

Na, Kook Joo; Fujita, Hiromasa

Abstract

In order to evaluate the efficacy of surgical treatment, we studied 103 patients with surgically resected superficial esophageal cancer. Evaluation was performed according to clinical findings, pathological findings, gross type, depth of invasion, lymph node metastasis, lymphatic invasion, vascular invasion, size of the lesion and operative results. There was 9 Tis cancers, 10 lpm, 13 mm, 15 sm1, 24 sm2, and 32 sm3. Lymphatic invasion, lymph node metastasis or recurrence was observed as cancer invades deeper than the muscularis mucosa. In case of Tis or lpm cancers, lymph node metastasis, lymphatic invasion, or blood vessel invasion was not recognized, but in case of mm, sm1, sm2, and sm3, lymph node metastasis was recognized in 15.4%, 26.7%, 16.7%, 43.8%, respectively. The incidence of recurrent node was 15.4%, 40%, 25% and 37% in mm, sm1, sm2 and sm3 lesions respectively. The right recurrent laryngeal nerve node and periesophageal nodes were most frequent recurrent site. According to gross type of lesions, the rate of lymph node metastasis was more than 30% in 0-I, 0-IIc+0-IIa, 0-IIa+0-IIb, and 40% in 0-III type superficial cancer lesions. 0-III cases and 0-I cases were submucosal cancers and almost all of the 0-IIb cases were Tis or lpm tumors. The 5-year survival except hospital death was 85.7% in Tis and lpm lesion, 79.1% in mm and sm1 lesion, 63.1% in sm2 and sm3 lesion. The prognostic factors to survival were age, depth of invasion, lymphatic invasion, lymph node metastasis and dissection, and operative approach(p<0.05). In conclusion, the depth of invasion and lymph node metastasis are the best guide as strategy of treatment of superficial esophageal cancer, however the accuracy of diagnostic tools is relatively low yet, and then further development is required to improve the diagnostic accuracy. Continued interest and evaluation is required for strategy of treatment of superficial esophageal cancer.