Treatment Strategy of m3 and sm1 Esophageal Cancer Based on the Clinical Results of Endoscopic Resection Associated with Adjuvant Treatments Kumiko Momma 1 , Misao Yoshida 2 , Junko Fujiwara 1 , Hideto Egashira 3 , Sawako Kuruma 3 , Naoto Egawa 3 , Akinori Miura 4 , Tsuyoshi Kato 4 , Yousuke Izumi 4 , Tetsuo Nemoto 5 , Nobuaki Funada 5 1Department of Endoscopy, Tokyo Metropolitan Komagome Hospital, Tokyo 2Ebara Hospital, Tokyo Metoropolitan Health and Medical Treatment Corporation, Tokyo 3Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 4Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo 5Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo Keyword: 食道m3 , 食道sm1 , 内視鏡的食道粘膜切除 , 脈管侵襲 , リンパ節転移 pp.1447-1458
Published Date 2006/9/25
DOI https://doi.org/10.11477/mf.1403100660
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 Treatment strategy for m3 and sm1 esophageal cancer was studied by observing the clinical result in 81 patients(m3 : 58 and sm1 : 23)who had pathologically proved m3 and sm1 esophageal cancer and underwent endoscopic treatment using mucosal resection(EMR)or endoscopic submucosal dissection(ESD), from 1990 to 2004. Additional treatments after EMR or ESD were decided considering the general condition of the patients and pathological findings such as the depth of cancer invasion, the size of m3 invasion, the micro-vascular permeation and the mode of invasion. No adjuvant treatment was employed in 70% of all patients(m3 : 49 and sm1 : 8)because they showed a very low incidence of micro vascular permeation. Radiation or chemoradiation(21% of all cases), chemotherapy(4%)and radical esophagectomy(4%)were employed for patients with pathological findings of micro vascular permeation. Five patients(6.2% of all cases : 3.4% of all m3 and 13% of sm1)developed lymph node recurrence and one patient died(1.7% of all patients). Considering the above facts, the indication for additional treatments after endoscopic resection of m3 and sm1 esophageal cancer is probably decided on clinico pathological findings. 1)In cases with superficial esophageal cancer with simple type 0-IIc, they probably have shallow invasion reaching only to the muscularis mucosae(m3)and they seldom show micro vascular permeation. For such cases, no additional treatment is recommended after EMR or ESD. 2)In cases with superficial esophageal cancer with mixed type or with type 0-III cancers, adjuvant treatments are recommended because of their high incidence of deep m3 invasion and micro vascular invasion.

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