J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text HTML] [Full Text PDF] （in Japanese / 260KB） [Members Only]

J.Jpn. Surg. Soc.. 112(2): 89-93, 2011

Feature topic

RECENT ADVANCES IN ENDOSCOPIC RESECTION FOR ESOPHAGEAL CANCER

1) Department of Surgery, Tokai University Oiso Hospital, Kanagawa, Japan
2) Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan

Hideo Shimada1), Soji Ozawa2), Osamu Chino2), Takayuki Nishi1), Tomoko Hanashi2), Soichiro Yamamoto2), Minoru Nakui2), Akihito Kazuno2), Hiroyasu Makuuchi2)

The indications for endoscopic resection (ER) in esophageal cancer are limited to cases without lymph node metastasis because it is a local therapy. The relationship between cancer depth and lymph node metastasis has been clarified according to the pathologic analysis of lymph nodes removed during esophagectomy for early esophageal cancer. Cancer invasion remaining in the lamina propria mucosa rarely metastasizes to the lymph nodes, and ER is thus indicated. ER allows the esophagus to be preserved and is less invasive, enabling the specimen to be examined pathologically. Lesions extending to a large area can be resected by repeated endoscopic mucosal resection (EMR), but have recently been resected en bloc in the endoscopic submucosal dissection (ESD) procedure, which is also indicated for the treatment of gastric cancer. The selection of EMR or ESD depends on the size of the lesion, the technique of the surgeon, the time the patient can safely spend under anesthesia, and economic management. ER is now employed in T1a-MM, SM1 cases without lymph node metastasis, although some require additional treatment including surgery after pathologic examination of the resected lesions.

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