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Recurrence after endoscopic mucosal resection of esophageal squamous cell carcinoma invading the muscularis mucosae or upper submucosa
Author(s) -
Shimizu Yuichi,
Tsukagoshi Hiroyuki,
Fujita Masahiro,
Hosokawa Masao,
Kato Mototsugu,
Asaka Masahiro
Publication year - 2003
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1046/j.1443-1661.2003.00259.x
Subject(s) - medicine , submucosa , endoscopic mucosal resection , muscularis mucosae , lymph node , esophagus , metastasis , carcinoma , dissection (medical) , mediastinal lymph node , esophagectomy , surgery , esophageal cancer , radiology , cancer , endoscopy , pathology
Background: Endoscopic mucosal resection (EMR) is recommended for cases of squamous cell carcinoma of the esophagus in which the tumor is confined to the lamina propria mucosa. However, EMR is often performed in patients whose tumors invade the muscularis mucosae (m3) or upper submucosa (sm1) to minimize surgical invasion, despite the increased risk of lymph node metastasis. We evaluated patients who were found to have distant or lymph node metastasis after EMR for such lesions. Methods: Thirty‐four consecutive patients with esophageal carcinoma invading m3 or sm1 who underwent EMR during the period from June 1992 through March 2001 (extended EMR group) were studied. Results: Five of these patients were found to have distant or lymph node metastasis on follow up. Patient 1 died of lung metastasis 34 months after EMR. Patient 2 underwent chemotherapy because of an abnormally high value of squamous cell carcinoma (SCC) antigen. Patient 3 died of upper mediastinal lymph node metastasis 62 months after EMR. Patient 4 underwent total gastrectomy because of gastric wall metastasis 41 months after EMR and underwent chemoradiotherapy because of upper mediastinal lymph node metastasis 87 months after EMR. Patient 5 was found to have cardiac lymph node metastasis by follow‐up endoscopic ultrasonography examination 42 months after EMR and underwent curative lymph node dissection. Conclusion: It is unlikely that patient 1 and patient 2, both with probable distant metastasis, received inadequate treatment. Surgery with lymph node dissection usually cannot prevent distant metastasis. The patients with lymph node recurrence (patient 3 and patient 4) should have been followed up more carefully. We believe that patients with early lymph node metastasis, such as patient 5 in this study, should undergo curative surgical resection. Patients undergoing extended EMR should be carefully followed up for a long period to enable early detection and treatment of lymph node metastasis.