Endoscopic resection for T1a-MM and T1b-SM1 squamous cell carcinoma of the esophagus

Abstract

In Japan, the first paper on endoscopic resection (ER) for squamous cell carcinoma (SCC) of the esophagus confined to the mucosa was reported as endoscopic mucosal resection (EMR) in 1988. Since publication of that article, ER has been recommended as the standard treatment for squamous and mucosal cancer of the esophagus. T1a-EP and T1a-LPM esophageal cancer seldom involves lymph node metastasis. However, in cases of T1a-MM and T1b-SM1 esophageal cancer with lymph node metastasis (10% to 30%), the indication of ER is limited. The risk factors for lymph node metastasis in T1a-MM and T1b-SM1 esophageal cancer were cleared by clinical and pathological studies. Endoscopic findings such as type 0-I or type 0-III, size of 50 mm or more, and pathological findings such as lymphatic permeation, venous permeation, poorly differentiated SCC and INFb or INFc were suggestive of high risk for lymph node metastasis. In addition, histopathological findings of small cancer nests, defined as "budding" or "droplet infiltration," suggest frequent lymph node metastasis. In cases of T1a-MM and T1b-SM1 esophageal cancer with high risk of lymph node metastasis, adjuvant therapy including chemoradiotherapy and radical esophagectomy are recommended after ER. A recent advance in ER for esophageal cancer is the establishment of endoscopic submucosal dissection (ESD). It has allowed us to perform an en-block resection of a large mucosal lesion of the esophagus and detailed histopathological examination. However, ESD requires more difficult manipulation than EMR. The indication of EMR or ESD is sought.

Efficacy of double‐scope endoscopic submucosal dissection and long‐term outcomes of endoscopic resection for superficial pharyngeal cancer

“…12 We diagnosed this if the local cancer cell nest had less than four cancer cells. 12 We diagnosed this if the local cancer cell nest had less than four cancer cells.…”

“…Droplet infiltration is a type of invasion in which cancer cells invade locally from the main advanced part of the lesion, and is reported to be a risk factor of LN metastasis in esophageal cancer. 12 We diagnosed this if the local cancer cell nest had less than four cancer cells.…”

Additional radiotherapy following endoscopic submucosal dissection for T1a-MM/T1b-SM esophageal squamous cell carcinoma improves locoregional control

“…Pathological T1a-intraepithelial cancer or pT1a-cancer within the lamina propria mucosae has a very low risk of lymph node metastasis; therefore these cancers are potentially curable by endoscopic resection alone [ 2 , 3 ]. On the other hand, the incidence of lymph node metastases in ESCC involving the muscularis mucosae (pT1a-MM) and the upper third of the submucosa (less than 200 μm below the MM; pT1b-SM1) is reported to range from approximately 4.2% to 30% [ 2 , 4 ]. The standard treatment for ESCC involving pT1a-MM or pT1b-SM1 is surgical resection.…”

“…The standard treatment for ESCC involving pT1a-MM or pT1b-SM1 is surgical resection. However, because of the relatively low risk of lymph node metastasis, endoscopic resection can be used as a less invasive treatment option [ 4 ]. Endoscopic submucosal dissection (ESD), an advanced form of endoscopic resection, enables en bloc resection of a larger mucosal lesion and more precise histological assessment compared with endoscopic mucosal resection (EMR) [ 3 ].…”

A case of lymph node metastasis after endoscopic mucosal resection of esophageal cancer invading the muscularis mucosa

“…The 5-year survival rate in T1a-MM esophageal cancer was 93.8 % and that in T1b-SM1 esophageal cancer 100 %. The survival rate of T1a-MM and T1b-SM1 esophageal cancer treated by EMR strongly suggests that EMR is as effective as radical surgery [17]. Hence, these indication determination criteria had been believed to be acceptable.…”