Surgical treatment of superficial esophageal cancer

Abstract

The conclusions drawn from those articles showed that the overall prevalence of SEC accounted around 10% and increased to 25% in the 2000s. The overall incidence of lymph node metastasis of SEC was about 25% and its incidences in mucosal and submucosal cancer were 5 and 35%, respectively. The percentage of the cases of squamous cell carcinoma (SCC) vs adenocarcinoma (AC) widely varied depending on the geographic locations reported; most SCC cases were from the Asian countries and most AC cases were from the European countries. Clinical significance of multimodal treatment for SEC has dramatically developed in the recent era and could provide various potential therapeutic options for SEC. These concepts make it possible to individualize surgical management of SEC as part of various multimodal treatments. The operative approaches for SEC varied from minimally invasive thoracoscopic esophagectomy, limited transabdominal distal esophagectomy, conventional transthoracic esophagectomy, transhiatal esophagectomy without thoracotomy, en bloc esophagectomy, and to extended esophagectomy with a complete three-field lymph node dissection. A 5-year overall survival rate of SEC after esophagectomy was good (46 to 83%) to excellent (71 and 100%) for mucosal SEC, but far from satisfactory (33 and 78%) for submucosal SEC. Early diagnosis, development of multimodal treatment, standardization of the surgical procedure including routine lymph node dissection, and improved perioperative management of patients have led to a better survival for patients with SEC.

Surgical Treatment for Early Esophageal Squamous Cell Carcinoma

“…The incidence of patients with EEC has been increasing because of recent advances in endoscopic examinations and awareness of the clinical importance of Barrett's esophagus (Ishikawa et al, 2005;Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;DeMeester, 2010). Chaoshan area in Guangdong province, located at the southeast of China, is the only coastal region with a high incidence of esophageal cancer in China.…”

“…This definition also included patients who had resection for high-grade dysplasia (HGD), now termed intraepithelial neoplasia (HGIEN) (Schlemper et al, 2000). The incidence of patients with EEC has been increasing because of recent advances in endoscopic examinations and awareness of the clinical importance of Barrett's esophagus (Ishikawa et al, 2005;Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;DeMeester, 2010). Radical esophagectomy with lymphadenectomy are still the mainstay of curative treatment for patients with EEC at many centers, especially for patients with submucosal diseases (Stein et al, 2005).…”

“…However, surgery has been challenged due to high morbidity and mortality rates related to the procedure and the low rate of lymph node metastases in EEC. Less invasive approach such as limited surgical resection, organ-preserving treatment and endoscopic therapy have been developed and applied in clinic (Stein et al, 2005;Westerterp et al, 2005;Tachibana et al, 2006;Saha et al, 2009;Barbour et al, 2010;Watanabe et al, 2010).…”

Comparison of oncological outcomes after laparoscopic transhiatal and open esophagectomy for T1 esophageal adenocarcinoma

“…Most studies that have studied patterns of recurrence of pT1 disease have analysed squamous cell and adenocarcinoma types together and report an incidence of recurrence from 0% (only T1a patients) to 25.3% [23]. In studies that focussed on adenocarcinoma, recurrence varied from 9.4% to 15.6% [7,17] and recurrence was higher in patients with submucosal invasion and affected locoregional and distant sites equally [23]. Poorly differentiated tumour has been shown to be prognostic for survival on univariate analysis but has not been shown to be independently significant in previous series [19].…”

Évolution favorable à long terme des patients traités par résection muqueuse endoscopique pour une dysplasie de haut grade ou un cancer épidermoïde superficiel de l’œsophage

“…La SG à cinq ans était excellente et comparable à celle reportée dans la littérature [20,21]. La SG à cinq ans après un traitement chirurgical de ces lésions superficielles est aussi élevée, mais la morbidité (10 à 50 %) et la mortalité sont supérieures, dépendant de l'expertise du centre où est réalisé le traitement chirurgical (la mortalité peut effectivement varier entre 5 et 10 %) [22][23][24][25][26]. Pour les tumeurs classées pT1m3 et pT1sm, aucune réci-dive n'a été observée après un traitement complémentaire par radiochimiothérapie.…”