How Radical Should Surgery Be for Early Esophageal Cancer?

Bogoevski, Dean; Bockhorn, Maximilian; Koenig, Alexandra M.; Reeh, Matthias; Loga, Katharina von; Sauter, Guido; Rösch, Thomas; Izbicki, Jakob R.

doi:10.1007/s00268-011-1069-8

Cited by 13 publications

(9 citation statements)

References 73 publications

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“…Therefore, endoscopic resection is limited to patients with high-grade dysplasia or mucosal tumors (Korn, 2004), especially for patients with high-grade dysplasia, as no lymph node metastases and systemic disease reported. Most of the previous studies confirmed that lymph node metastases were rare in patients with mucosal tumor (Endo et al, 2000;Fujita et al, 2001;DeMeester, 2010;Bogoevski et al, 2011), but some studies reported a rate of higher than ten percent for lymph node metastases in mucosal tumor (Matsubara et al, 1999). It is hard to identify patients with high risk of lymph node metastases in mucosal tumor in our study as only one of the 62 patients with mucosal tumor had lymph node metastases (1.6%).…”

Section: Discussionmentioning

confidence: 53%

“…Due to the improvement of endoscopy and staining methods, the detection rate of EEC in our hospital rose significantly in the past five years, and reached to nearly 10%. But the detection rate is still lower than that of 15%-30% in Japan and western countries (Natsugoe et al, 2004;Stein et al, 2005;Saha et al, 2009;Bogoevski et al, 2011;Dubecz et al, 2012).…”

Section: Discussionmentioning

confidence: 97%

“…But when the tumor infiltrates the basement membrane and enters the lamina propria, lymph node metastases can occur. The incidence of lymph node metastases in early ESCC was 0%-15.6% for mucosal tumor and 17.1%-48.7% for submucosal tumor (Sugimachi et al, 1989;Matsubara et al, 1999;Fujita et al, 2001;Endo et al, 2000;Stein et al, 2005;Bogoevski et al, 2011;Tanaka et al, 2012). In the current study, only one of the 62 patients with mucosal tumor had lymph node metastases (1.6%), while twenty-seven of the 148 patients with submucosal tumor had lymph node metastases (18.2%).…”

Section: Discussionmentioning

confidence: 98%

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Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Chen

Weng²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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More studies are needed to clarify treatments and prognosis of early esophageal squamous cell carcinoma (ESCC). This retrospective study was designed to review the outcome of surgical treatment for early ESCC, evaluate the results of a left thoracotomy for selected patients with early ESCC, and identify factors affecting lymph node metastases and survival. The clinicopathological data of 228 patients with early ESCC who underwent transthoracic esophagectomy with lymphadenectomy without preoperative adjuvant treatment were reviewed. The χ 2 test or Fisher's exact test were used to detect factors related to lymph node metastasis. Univariate and multivariate analyses were performed to identify prognostic factors. There were 152 males and 76 females with a median age of 55 years. Two hundred and eight patients underwent a left thoracotomy, and the remaining 20 patients with lymph nodes in the upper mediastinum more than 5 mm in short-axis diameter by computed tomography scan underwent a right thoracotomy. No lymph node metastasis was found in the 18 patients with carcinoma in situ, while lymph node metastases were detected in 1.6% (1/62) of patients with mucosal tumours and 18.2% (27/148) of patients with submucosal tumours. Only 7 patients showed upper mediastinal lymph node metastases in the follow-up. The 5-and 10-year overall survival rates were 81.4% and 70.1%, respectively. Only histologic grade (P<0.001) and pT category (P=0.001) significantly correlated with the presence of lymph node metastases. In multivariate analysis, only histologic grade (P=0.026) and pT category (P=0.008) were independent prognostic factors. A left thoracotomy is acceptable for selected patients with early ESCC. Histologic grade and pT category affected the presence of lymph node metastases and were independent prognostic factors for early ESCC.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

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Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Chen

Weng²,

Wang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…A large number of studies analyzing the results of surgical treatment of ESCC involve cohorts that also comprise esophageal adenocarcinoma 3,9,15,18,23,33,36,37,38 . Moreover, several studies do not discriminate the results of esophagectomy by tumor type (ESCC vs. esophageal carcinoma).…”

Section: Discussionmentioning

confidence: 99%

Transhiatal Esophagectomy in Squamous Cell Carcinoma of the Esophagus: What Are the Best Indications?

Vieira

Chedid

Gurski

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. Aim: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. Methods: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. Results: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. Conclusion: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

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“…Proximal gastrectomy combined with jejunal interposition reconstruction has become an ideal choice for the treatment of for Siewert II and III AEG, since studies have shown that it can ensure the surgical safety, achieve an ideal radical cure, and achieve comparable 5-year overall survival with TG [5–7]. In China, piggyback jejunal interposition reconstruction (PJIR), proposed by Shanxi Tumor Hospital, was performed on the basis of Roux-en-Y jejunal anastomosis on the jejunum of the esophagus, and then jejunal remnant jejunostomy was performed on the appropriate location of jejunum loop.…”

Section: Introductionmentioning

confidence: 99%

Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study

Dong

Huang

et al. 2019

World J Surg Onc

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BackgroundThe incidence of adenocarcinoma of esophagogastric junction (AEG) has recently risen worldwide, including in Eastern Asia. The aim of the study was to explore the short-term and long-term clinical efficacy of piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR), piggyback jejunal interposition reconstruction double-tract reconstruction (PJIRDTR), and total gastrectomy esophageal jejunal Roux-en-Y anastomosis (TGRY) for the treatment of Siewert II and III AEG patients.MethodsA total of 300 Siewert II and III AEG patients admitted to Shanxi Tumor Hospital from June 2015 to December 2017 were prospectively selected. Patients were randomly divided into PJIRSTR group (n = 98), PJIRDTR group (n = 103), and TGRY group (n = 99) using the random number table method.ResultsThere were no statistically significant differences in total operation time, intraoperative blood loss, time of first anal exhaust, and postoperative hospital stay among the three groups (F = 2.526, 0.457, 0.234, 0.453; P > 0.05). The reconstruction time of PJIRSTR group and PJIRDTR group was longer than that of TGRY group (P < 0.01). There were no significant differences in cases of anastomotic leakage, anastomotic bleeding, abdominal infection, incision infection, ileus, and dumping syndrome in three groups (P > 0.05). The incidence of reflux esophagitis at 3, 6, 12, and 18 months after surgery in the PJIRSTR group and the PJIRDTR group were significantly lower than TGRY group in the same period (P < 0.05). Compared with PJIRDTR group and TGRY group, PJIRSTR group had a small fluctuation range of postoperative nutrition indexes and had basically recovered to the preoperative level at 18 months. Four patients of Visick grade IV presented in TGRY group 18 months postoperatively, which was significantly higher compared with the other two groups.ConclusionCompared with PJIRDTR and TGRY, PJIRSTR can significantly reduce the incidence of postoperative reflux esophagitis and improve the long-term nutritional status of patients.Trial registrationChinese Clinical Trial Registry, ChiCTR-IIR-16007733. Registered 07 November 2015 – Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx.

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How Radical Should Surgery Be for Early Esophageal Cancer?

Abstract: Limited resection leads to lower lymph node yield but similar oncologic effectiveness as the extensive surgery. It may represent a valuable alternative in the treatment of patients with early (submucosal) esophageal carcinoma.

Cited by 13 publications

References 73 publications

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

Transhiatal Esophagectomy in Squamous Cell Carcinoma of the Esophagus: What Are the Best Indications?

Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study

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