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Clinicopathologic Features of Superficial Esophageal Cancer: Results of Consecutive 100 Patients

  • Gastrointestinal Oncology
  • Original Paper
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The depth of tumor penetration is a crucial factor in determining the prognosis of patients with esophageal carcinoma. Patients with superficial esophageal carcinoma (SEC) have a far more favorable clinical course compared with those with advanced cancers. The outcome for patients with mucosal cancer is excellent with a 5-year survival rate exceeding 80%. On the other hand, submucosal cancer often metastasizes to regional and/or distant lymph nodes or other organs, and the prognosis of these patients are far from satisfactory.

Methods

Among 334 patients with esophageal cancer who underwent surgery between December 1980 and December 2006, 100 patients (30%) had SEC confined to the epithelium, lamina propria mucosa, or submucosa. Patient and tumor characteristics of those 100 patients were studied.

Results

The prevalence of SEC has increased from 13% (8 of 61) in the initial 5-year period (1985–1989) to 44% (41 of 93) in the recent 7-year period (2000–2006). Subjective symptoms were present in 7 (14%) of 51 mucosal cancers and in 13 (27%) of 49 submucosal cancers. The remaining 80 patients (80%) had no subjective symptoms. Ninety-one patients (91%) were diagnosed to have the lesions by endoscopy at the time of screening for gastric problems, and only nine were detected by gastrointestinal series. Four of 51 patients with mucosal cancer had venous or lymph vessel invasion, and among those, only one (2%) had a solitary perigastric lymph node metastasis. In 49 patients with submucosal cancer, 35 (71%) had lymph vessel invasion, 28 (57%) had venous invasion, and 16 (33%) had lymph node metastases. In particular, 15 of 35 patients with positive lymph vessel invasion had lymph node metastasis, whereas only 1 of 14 with negative lymph vessel invasion had lymph node metastasis (P < .05). Among 17 patients with nodal involvement, 4 patients with upper thoracic SEC had upper mediastinum and/or cervical nodal metastases, 11 patients with middle thoracic SEC had widespread upper and lower mediastinal and abdominal metastases, and 2 patients with lower thoracic SEC had lower and abdominal lymph node metastases. Seventy-nine patients were alive without recurrence at last follow-up. Five of 49 patients with submucosal cancer died of recurrent disease, and 4 of these developed regional nodal recurrence around the bilateral laryngeal recurrent nerves. Forty-two patients (42%) developed double cancers during the follow-up period, and 5 died of a second cancer. The 3- and 5-year survival rates of all 100 patients were 85% and 73%, and those disease-specific survival rates were 96% and 93%, respectively. The 3- and 5-year survival rates for patients with mucosal cancer were 89% and 83%, and those for submucosal cancer were 80%, and 64%, respectively.

Conclusions

Esophagectomy with extensive lymphadenectomy should be carried out particularly for upper thoracic submucosal cancer, whereas esophagectomy with moderate lymphadenectomy may be preferred for mucosal cancer. Patients with SEC should be examined for another primary cancer preoperatively and periodically during follow-up.

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Authors and Affiliations

  1. Digestive Surgery, Department of Surgery, Faculty of Medicine, Shimane University, Izumo, 693-8501, Japan

    Mitsuo Tachibana MD, Noriyuki Hirahara MD, Shoichi Kinugasa MD & Hiroshi Yoshimura MD

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  1. Mitsuo Tachibana MD
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  2. Noriyuki Hirahara MD
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  3. Shoichi Kinugasa MD
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  4. Hiroshi Yoshimura MD
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Correspondence to Mitsuo Tachibana MD.

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Tachibana, M., Hirahara, N., Kinugasa, S. et al. Clinicopathologic Features of Superficial Esophageal Cancer: Results of Consecutive 100 Patients. Ann Surg Oncol 15, 104–116 (2008). https://doi.org/10.1245/s10434-007-9604-4

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  • DOI: https://doi.org/10.1245/s10434-007-9604-4

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