| Theme | Expansion of Indications for Endoscopic Mucosal Resection of Early Gastrointinal Cancer | |
|---|---|---|
| Title | Management of m3 and sm1 Carcinoma of Esophagus from a Surgical Viewpoint | |
| Publish Date | 2001/11 | |
| Author | Masao Hosokawa | The Department of Surgery, Keiyukai Sapporo Hospital |
| Author | Takaya Kusumi | The Department of Surgery, Keiyukai Sapporo Hospital |
| Author | Masanobu Kusano | The Department of Surgery, Keiyukai Sapporo Hospital |
| Author | Yasushi Tanabe | The Department of Surgery, Keiyukai Sapporo Hospital |
| Author | Tatsuya Abe | The Department of Surgery, Keiyukai Sapporo Hospital |
| Author | Masahiro Fujita | The Department of Pathology, Keiyukai Sapporo Hospital |
| [ Summary ] | Of 1,100 cases of preoperative, untreated carcinoma of the esophagus, 447 cases of superficial carcinoma were reviewed. The incidence of m3 was 13.9% (n=62); surgical resection was performed on 44. Endoscopic mucosal resection (EMR) was performed on 18 cases of superficial carcinoma and for cases of sm1 carcinoma, the percentage was 7.8% (n=35;surgical resection for 29, EMR for 6 cases). Macroscopic findings showed that 0-IIc comprised 59.7% of m3 carcinoma cases, but the mixed type predominated in cases of sm1 carcinoma. In patients undergoing surgical resection for m3 (n=44) or sm1 (n=29) carcinoma., metastasis of the lymph nodes was found in 4 (9.1%) patients with m3 in 7 (24.1%) patients with sm1 carcinoma. Among those patients treated with surgery, 1 patient with m3 and 4 patients with sm1 died of cancer. Our therapeutic strategy for m3 and sm1 carcinoma is as follows: EMR is indicated for patients with M3 carcinoma, who are negative for metastasis of the lymph nodes, as assessed by EUS and CT. Further surgical resection is not necessary for m3 carcinoma, except for those with positive lymphovascular invasion, rugged lesions, or lesions longer than 5cm in diameter. Surgical resection is the first choice of treatment in patients with SM1 carcinoma. |
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