Treatment Strategy after Endoscopic Resection of Superficial Esophageal Squamous Cell Carcinoma: A Single Institution Experience
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Background/Aims: The aim of this study was to analyze and propose a treatment strategy after endoscopic resection of superficial esophageal squamous cell carcinoma in a single institution. Methods: This is a retrospective review of 37 patients who were treated by endoscopic resection during a 6-year period. Results: The mean tumor size was 11.5±5.5 mm (range, 3 to 31 mm). Thirty-one lesions (83.8%) were treated by endoscopic submucosal dissection, and six lesions were treated by endoscopic mucosal resection (16.2%). The en bloc resection rate and complete resection rate were 91.9% and 81.8%, respectively. The tumor invasion depth was diagnosed as epithelial in five cases (13.5%), lamina propria mucosa in 12 cases (32.4%), muscularis mucosa in 10 cases (27.0%) and submucosa in 10 cases (27.0%). The complication rate was 13.5% and included three cases (8.1%) of perforation. Ten patients who had muscularis mucosa and submucosa lesions received additional treatments, including six patients who were treated with esophagectomy, three patients who were treated with radiotherapy and one patient who was treated with chemoradiotherapy. One patient with lamina propria lesions received radiotherapy due to a positive resection margin. The median follow-up duration was 22 months (range, 4 to 79 months), and no recurrence or metastasis was noted during follow-up. Conclusions: Tailored management after endoscopic treatment of superficial esophageal squamous cell carcinoma can offer an acceptable oncologic outcome in early esophageal carcinoma.
Abstract
Background/Aims: The aim of this study was to analyze and propose a treatment strategy after endoscopic resection of superficial esophageal squamous cell carcinoma in a single institution. Methods: This is a retrospective review of 37 patients who were treated by endoscopic resection during a 6-year period. Results: The mean tumor size was 11.5±5.5 mm (range, 3 to 31 mm). Thirty-one lesions (83.8%) were treated by endoscopic submucosal dissection, and six lesions were treated by endoscopic mucosal resection (16.2%). The en bloc resection rate and complete resection rate were 91.9% and 81.8%, respectively. The tumor invasion depth was diagnosed as epithelial in five cases (13.5%), lamina propria mucosa in 12 cases (32.4%), muscularis mucosa in 10 cases (27.0%) and submucosa in 10 cases (27.0%). The complication rate was 13.5% and included three cases (8.1%) of perforation. Ten patients who had muscularis mucosa and submucosa lesions received additional treatments, including six patients who were treated with esophagectomy, three patients who were treated with radiotherapy and one patient who was treated with chemoradiotherapy. One patient with lamina propria lesions received radiotherapy due to a positive resection margin. The median follow-up duration was 22 months (range, 4 to 79 months), and no recurrence or metastasis was noted during follow-up. Conclusions: Tailored management after endoscopic treatment of superficial esophageal squamous cell carcinoma can offer an acceptable oncologic outcome in early esophageal carcinoma.
참고문헌 (26)
- Ferlay J, "Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008", Int J Cancer, 127, pp.2893~2917 (2010)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival and Prevalence in 2010", Cancer Research and Treatment, 45(1), pp.1~14 (2013), 대한암학회
- Pech O, "Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia", Endoscopy, 39, pp.30~35 (2007)
- Oyama T, "Endoscopic submucosal dissection of early esophageal cancer", Clin Gastroenterol Hepatol, 3, pp.S67~S70 (2005)
- Higuchi K, "Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma", Endoscopy, 39, pp.39~36 (2007)
- Sergio Coda, "Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection as Treatments for Early Gastrointestinal Cancers in Western Countries", Gut and Liver, 1(1), pp.12~21 (2007), 거트앤리버 발행위원회
- Kodama M, "Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan", Surgery, 123, pp.432~439 (1998)
- Nagawa H, "The relationship of macroscopic shape of superficial esophageal carcinoma to depth of invasion and regional lymph node metastasis", Cancer, 75, pp.1061~1064 (1995)
- Takubo K, "Lymph node metastasis in superficial squamous carcinoma of the esophagus", Pathologe, 34, pp.148~154 (2013)
- Japan Esophageal Society, "Japanese classification of esophageal cancer, tenth edition: part I", Esophagus, 6, pp.1~25 (2009)
- Birkmeyer JD, "Surgeon volume and operative mortality in the United States", N Engl J Med, 349, pp.2117~2127 (2003)
- Low DE, "Update on clinical impact, documentation, and management of complications associated with esophagectomy", Thorac Surg Clin, 23, pp.535~550 (2013)
- Pech O, "Endoscopic resection of early oesophageal cancer", Gut, 56, pp.1625~1634 (2007)
- Shimizu Y, "Long-term outcome after endoscopic mucosal resection in patients with esophageal squamous cell carcinoma invading the muscularis mucosae or deeper", Gastrointest Endosc, 56, pp.387~390 (2002)
- Das A, "A comparison of endoscopic treatment and surgery in early esophageal cancer: an analysis of surveillance epidemiology and end results data", Am J Gastroenterol, 103, pp.1340~1345 (2008)
- Ishihara R, "Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection", Cancer, 112, pp.2166~2172 (2008)
- Higuchi K, "A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms", Gastrointest Endosc, 78, pp.704~710 (2013)
- Pech O, "Endoscopic resection of superficial esophageal squamous-cell carcinomas: Western experience", Am J Gastroenterol, 99, pp.1226~1232 (2004)
- Shimizu Y, "Endoscopic resection (endoscopic mucosal resection", endoscopic submucosal dissection) for superficial esophageal squamous cell carcinoma: current status of various techniques, 2013, pp.25(1), 13~19
- Ishihara R, "Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan", Gastrointest Endosc, 68, pp.1066~1072 (2008)
- Takahashi H, "Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus", Gastrointest Endosc, 72, pp.255~264 (2010)
- Kurokawa Y, "A phase II trial of combined treatment of endoscopic mucosal resection and chemoradiotherapy for clinical stage I esophageal carcinoma: Japan Clinical Oncology Group Study JCOG0508", Jpn J Clin Oncol, 39, pp.686~689 (2009)
- Yamashina T, "Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma", Am J Gastroenterol, 108, pp.544~551 (2013)
- May A, "Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial", Gut, 53, pp.634~640 (2004)
- Zuccaro G Jr, "Endoscopic ultrasound errors in esophageal cancer", Am J Gastroenterol, 100, pp.601~606 (2005)
- Pech O, "The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus", Am J Gastroenterol, 101, pp.2223~2229 (2006)