Bo Ye1, Xiaobin Zhang1, Yuchen Su1, Shuguang Hao2, Haohua Teng3, Xufeng Guo1, Yu Yang1, Yifeng Sun1, Teng Mao1, Zhigang Li4. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Huaihaixi Road 241, Shanghai, 200030, People's Republic of China. 2. Department of Thoracic Surgery, Xinxiang Central Hospital, Xinxiang, 453000, Henan Province, People's Republic of China. 3. Department of Pathology, Shanghai Chest Hospital, Shanghai JiaoTong University, Huaihaixi Road 241, Shanghai, 200030, People's Republic of China. 4. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Huaihaixi Road 241, Shanghai, 200030, People's Republic of China. dr_lizhigang@163.com.
Abstract
BACKGROUND: We analyzed the pathological characteristics and recurrence pattern of cN0 submucosal esophageal cancer after esophagectomy and conducted risk stratification to determine the feasibility of performing endoscopic resection for cN0pT1b esophageal squamous cell malignancies. METHODS: We retrospectively enrolled 167 patients who underwent right-sided transthoracic esophagectomy and extended thoracic/abdominal two-field lymphadenectomy. Patients with pathologically confirmed lymph node metastasis or tumor recurrence constituted the high-risk group for endoscopic submucosal resection, and the remainder were defined as low risk. Factors affecting lymphatic metastasis and long-term recurrence were identified by univariate and multivariate analyses. RESULTS: Postoperative pathology showed that five patients (5/167; 3%) had lymph node metastases. Follow-up ranged from 12-60 months, with a median of 29 months. A total of 17 patients (10.2%) had recurrences during follow-up, including three patients with pathologic nodal metastasis (pN +) found at surgery. Invasion depth, differentiation, and tumor size differed significantly in high-risk patients. Overall 3-year survival rates were 94.2% (low-risk) and 40.9% (high-risk) (p < 0.01). Twenty-one patients with sm1 cancer, high tumor differentiation, and tumor length < 2 cm had no lymph node metastasis or lymphovascular invasion, and none of these patients experienced recurrence. CONCLUSIONS: Endoscopic submucosal resection alone may be feasible for patients with small (≤ 2 cm) clinically N0 submucosal esophageal squamous cell carcinoma with low invasion depth (sm1) and higher differentiation, but prospective studies are required for confirmation. Other patients require surgical resection with extended two-field thoracic/abdominal lymphadenectomy.
BACKGROUND: We analyzed the pathological characteristics and recurrence pattern of cN0 submucosal esophageal cancer after esophagectomy and conducted risk stratification to determine the feasibility of performing endoscopic resection for cN0pT1b esophageal squamous cell malignancies. METHODS: We retrospectively enrolled 167 patients who underwent right-sided transthoracic esophagectomy and extended thoracic/abdominal two-field lymphadenectomy. Patients with pathologically confirmed lymph node metastasis or tumor recurrence constituted the high-risk group for endoscopic submucosal resection, and the remainder were defined as low risk. Factors affecting lymphatic metastasis and long-term recurrence were identified by univariate and multivariate analyses. RESULTS: Postoperative pathology showed that five patients (5/167; 3%) had lymph node metastases. Follow-up ranged from 12-60 months, with a median of 29 months. A total of 17 patients (10.2%) had recurrences during follow-up, including three patients with pathologic nodal metastasis (pN +) found at surgery. Invasion depth, differentiation, and tumor size differed significantly in high-risk patients. Overall 3-year survival rates were 94.2% (low-risk) and 40.9% (high-risk) (p < 0.01). Twenty-one patients with sm1cancer, high tumor differentiation, and tumor length < 2 cm had no lymph node metastasis or lymphovascular invasion, and none of these patients experienced recurrence. CONCLUSIONS: Endoscopic submucosal resection alone may be feasible for patients with small (≤ 2 cm) clinically N0 submucosal esophageal squamous cell carcinoma with low invasion depth (sm1) and higher differentiation, but prospective studies are required for confirmation. Other patients require surgical resection with extended two-field thoracic/abdominal lymphadenectomy.
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