J.Jpn. Surg. Soc.. 93(9): 1059-1062, 1992

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Report on the annual meeting

CONTROVERSY IN THE TREATMENTS FOR SUPERFICIAL ESOPHAGEAL CARCINOMA
－INDICATIONS AND PROBLEMS OF THE PROCEDURES－

In our institution, 152 cases have been treated, which are 24.3% of total 626 cases with esophageal carcinomas. Analysis of these 152 cases revealed that neither intraepithelial cancer (ep), nor mm₂ cancer, in which the lesion is limited within the upper two-thirds of the proper mucosal layer, had any vessels invasion and lymph node metastases. In addition, only 25% of the cases with mm₃ cancer, limited within the deeper one-third of the proper mucosal layer, had vessels invasion without lymph node metastases. The 5-year survival of the cases less than sm₁ was as good as 100%. However, those of sm₂ and sm₃ patients were 58.9% and 54.2%, respectively. Thus, we made the treatment strategy for superficial esophageal cancer as follows :
1. For ep to mm₂ cases, endoscopic mucosal resection could be applied.
2. For the cases whose lesions widely spread in the esophagus, blunt resection would be indicated.
3. For the cases with mm₃ to sm₃ cancer, thoracotomy and laparotomy with wide lymph node dissection from neck to abdomen should be employed.
Since a radical operation for esophageal cancer has high operative risk and poor postoperative quality of life, we should properly pick up and apply more cases with mucosal carcinoma for endoscopic mucosal resection.

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