Korean J Gastroenterol.  2021 Dec;78(6):313-319. 10.4166/kjg.2021.155.

Treatment of Superficial Esophageal Cancer: An Update

• Shin CM

• KMID: 2523592
• DOI: http://doi.org/10.4166/kjg.2021.155

Abstract

Superficial esophageal squamous cell carcinoma (SESCC) is an esophageal squamous cell carcinoma confined to the mucosa or superficial submucosa. Recent Korean Guidelines recommend an endoscopic resection as the first-line treatment for SESCC without a distant or lymph node metastasis (LNM) after excluding those with an obvious submucosal invasion. Before endoscopic treatment of SESCC, Lugol chromoendoscopy or image-enhanced endoscopy is recommended to define the extent of the lesion, and endoscopic ultrasound is recommended to determine the T stage. The tumor size, macroscopic type of tumor, pathologic differentiation, depth of tumor, and lymphovascular invasion (LVI) are risk factors of LNM in SESCC. No additional treatment is necessary after an en bloc complete resection of SESCC invading no more than the lamina propria without LVI. Although the risk of LNM in a SESCC invading into muscularis mucosa without LVI is low, a close follow-up is recommended without additional treatment. On the other hand, additional treatment is recommended in the case of a tumor with submucosal invasion or an LVI positive or positive vertical resection margin. Adjuvant therapy includes esophagectomy or chemoradiotherapy (CRT), but it is unclear which treatment is better. The 5-year overall survival rates were reportedly 90-100% for esophagectomy and 75-85% for CRT. Nevertheless, patients with high-risk features including poorly differentiated histology, LVI positive, perineural invasion positive, T1b-SM2/T1b-SM3 cancer, and vertical resection margin positive need to be treated with an additional esophagectomy. Elderly patients, those with a physical condition and co-morbidities, and those with LNM or cancer-specific mortality require additional treatment after a non-curative endoscopic resection of SESCC.

Keyword

Esophageal squamous cell carcinoma; Endoscopic mucosal resection; Esophagectomy; Chemoradiotherapy; Lymphatic metastasis

Figure

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  Fig. 1 Determining the necessity for additional treatment after a non-curative endoscopic resection of superficial esophageal squamous cell carcinoma (SESCC).32 CRT, chemoradiotherapy; LVI, lymphovascular invasion; pT1a-M3, tumor invasion into the muscularis mucosa; pT1b-SM, tumor invasion into the submucosa. aFor patients with high-risk features (poorly differentiated histology, LVI positive, perineural invasion positive, T1b-SM2/T1b-SM3 cancer, and vertical resection margin positive), additional esophagectomy is recommended first.

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