Open AccessA Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions
Author(s) -
Aleksandar Simić,
Ognjan Skrobić,
Predrag Peško
Publication year - 2019
Publication title -
digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.879
H-Index - 66
eISSN - 1421-9875
pISSN - 0257-2753
DOI - 10.1159/000500120
Subject(s) - medicine , lymphovascular invasion , esophagogastric junction , endoscopic mucosal resection , esophageal cancer , endoscopic submucosal dissection , cancer , lymph node , dissection (medical) , gastroenterology , surgery , endoscopy , adenocarcinoma , metastasis
Background: Endoscopic mucosal resection and submucosal dissection (ESD) are indicated in a majority of mucosal esophageal, esophagogastric junction and gastric cancers (GC), and selected cases of submucosal cancers as well. Summary: The presence of lymph node metastases in early esophageal cancer (EC) has been proven in up to 50% of patients with sm3 cancers treated with surgical resection, and up to 18.5 and 30.5% in sm1 and sm2 cancer respectively. The presence of lymphovascular invasion (LVI), tumor depth >500 μm and poor tumor differentiation seem to be a common predictor of worse outcomes in literature reports. In case of early esophagogastric junction cancer (EGJC) these predictors include LVI, tumor size >3 cm, Barrett’s origin of the tumor and ulcerative tumor appearance. Extended indications for ESD in early GC are already adopted in high volume centers with high success rates (up to 98%). Jet, positive resection margins after ESD, LVI and poor tumor differentiation carry high metastatic potential, therefore advocating surgery. Limited resections and cooperative laparoscopic endoscopic approach may be implemented in cases of early EGJC and GC. Key Messages: The presence of LVI, depth of submucosal invasion, and poor tumor differentiation in cases of early EC, EGJC, and GC favor surgical treatment despite improvements in endoscopic techniques.