[Endoscopic mucosal resection for esophageal cancer].Gan To Kagaku Ryoho. 2003 Jul; 30(7):914-9.GT
Lymph node metastasis or microvascular permeation is rare among esophageal cancer which remains within the epithelium or the lamina propria mucosae. Endoscopic mucosal resection (EMR) is recommended for them as a radical treatment. Radical esophagectomy had been indicated for esophageal cancer reaching to the muscularis mucosae for their incidence of lymph node metastasis (10%). Recently, number of m3 or sm1 cancer cases treated by EMR has been increased, for some clinical trial succeeded to show that there is no significant difference between the prognosis of patient treated by EMR and by surgery. Thirty one patients (14%) have been lost among 219 patients who underwent EMR (mucosal cancer: 196 and submucosal cancer: 23). Four cases (13% of all patients lost after EMR) died of esophageal cancer, (one case with m3 cancer was lost by lymph node metastasis, one with sm2 cancer by liver metastasis, and two patients who refused surgical treatment by local recurrence after EMR), nineteen by other diseases than esophageal cancer and eight by cancer at other organs (lung: 3, hypoharynx: 2, mesopharynx: 1, stomach: 1, ureter: 1). Three of them were found concomitantly and 5 metachronously. Local recurrence was found in 8.3% of all patients treated by EMR. All patients with recurrence had received piecemeal resection. Sixty seven percents of all lesion of local recurrence was detected by endoscopic surveillance within one year after EMR. All recurred lesions were treated by EMR and pathological studies on resected specimens revealed that all recurred lesions were mucosal cancer. Metachronous esophageal cancer was found in 11% of all EMR cases. Sixty five percent of all metachronous cancer were detected in one to three years after EMR. Metachronous esophageal cancer after EMR was frequently found among cases with esophageal mucosa which has many small unstained areas. Malignant lesions were found in 33 cases (15%) of all patients treated by EMR synchronously and 37 (17%) metachronously. The stomach and the head and neck are most frequent site of associated cancers.