Endoscopic Mucosectomy for Mucosal Carcinomas in the Esophagus.

Endoscopic resection in neoplastic lesions of the oesophagus

“…Japanese endoscopists carried out the first ER procedures for early oesophageal carcinoma in the early 1990s [1,2]. It was only several years later that the first Western research groups published their experience in ER for oesophageal neoplasias [3,4].…”

Surgical Treatment of Early Esophageal Cancer

“…The prognostic signifi cance of these recent findings is not yet well defined; how ever, preliminary comparisons show that gastric cancer patients with microinvolvement of lymph nodes have a worse prognosis than those without microcarcinosis [49], These examinations have not yet been confirmed in early esophageal cancer but it is probable that the rate oflymph nodes with microinvolvement is also much higher than the pN l rate judged by routine histological work-up. The findings about lymph node métastasés have im portant clinical consequences especially for the discussion about limited endoscopic resections [37], An endoscopic mucosectomy only can be considerd sufficient in treating mucosal cancer, whereas in submucosal cancer this local excision would be inadequate for approximately 30% of the patients because of residual lymph node métastasés (table l). Analysis of the exact localisation of the infil trated lymph nodes in the pNl cases of our material showed that radical lymphadenectomy in early submuco sal cancer is meaningful [3], In most pNl cases of the AC or SCC group only regional lymph node metastases were found.…”

“…Preliminary re sults show that the accuracy of the staging of T1 tumors can be increased by application of 20-MHz probes for endoscopic ultrasonography but to date, this is not yet a routine procedure [56][57][58]. The expertise of some Japa nese authors with solely endoscopic staging of the depth of infiltration of Tl esophageal cancer has not yet been con firmed by others [ 19,33,37], Subtotal esophagectomy and lymphadenectomv for early esophageal cancer can be performed in two ways according to histology and localization of the carcinoma. As SCC is predominantly localized in the middle and low er intrathoracic esophagus, lymph node metastases are mostly found in the mediastinum.…”

“…These data about multicentricity and lymphangiosis support the opinion that subtotal esopha gectomy should be performed in patients with early esophageal cancer. If endoscopic local mucosectomy is considered as a possible treatment for early cancer these patients should have endoscopic Lugol's staining to ex clude the presence of multiple primary lesions [35][36][37][38]. The multifocal development of T1 Barrett's cancer with additional foci of high grade dysplasia or carcinoma in situ is a well-known fact [39][40][41], Therefore, it is generally accepted that the whole columnar cell-lined lower esopha gus must be resected.…”

Multimodality treatments with endoscopic mucosal resection of esophageal squamous cell carcinoma with submucosal invasion

“…On the other hand, nonoperative treatment such as chemotherapy and radiotherapy are commonly performed. Endoscopic mucosal resection (EMR) is usually performed for esophageal mucosal cancer as a curative treatment [3,10,12]. At our institute, EMR with chemotherapy, radiotherapy, or chemoradiotherapy has been performed for esophageal SCC with submucosal invasion.…”