Clinical Outcome of Endoscopic Mucosal Resection for m1・m2 Esophageal Cancer Kenro Kawada 1 , Tatsuyuki Kawano 1 , Hiroshi Kawachi 2 , Maki Kobayashi 3 , Yoshinobu Eishi 3 , Shigeo Haruki 1 , Kazuo Ogiya 1 , Yasuaki Nakajima 1 , Tetsurou Nishikage 1 , Kagami Nagai 1 1Department of Esophago-gastric Surgery, Tokyo Medical and Dental University, Tokyo 2Department of Pathology, Tokyo Medical and Dental University Hospital, Tokyo 3Department of Human Pathology, Tokyo Medical and Dental University Hospital, Tokyo Keyword: 食道m1・m2 , EMR , 長期予後 , 局所再発 , 他臓器重複癌 pp.1317-1322
Published Date 2007/8/25
DOI https://doi.org/10.11477/mf.1403101168
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 Endoscopic mucosal resection(EMR)has become a standard therapy for early esophageal cancer that is confined to the mucosa(m1:invaded to the epithelium, m2:invaded to the lamina propria mucosae), without lymph node metastasis.

 We reviewed our clinical experience regarding EMR for the treatment of m1・m2 esophageal cancer in 214 patients with 238 lesions(m1=140, m2=98)between December, 1989 and March, 2005. Among them, synchronous multiple primary cancers were found in 21 cases(9.8%).

 Local recurrence of the disease after EMR was detected in 19 cases(8.9%). The median time to local recurrence after EMR was 12 months(range 3~33 months). Of the 19 patients with recurrent lesions, 16 underwent endoscopic treatment. Among the remaining 3 patients, 2 patients were treated with radiotherapy, while 1 patient was operated on. Neither lymph node metastases nor distant metastases were identified.

 Metachronous multiple primary cancers were found in 22 cases(10.3%). The median time needed to detect metachronous multiple primary cancers after EMR was 38 months(range 14~144 months). All of the patients were cured by endoscopic treatment.

 In 72 cases(33.6%), out of a total of 214 cases treated by EMR for m1・m2 esophageal cancer, cancer also occurred in organs other than the esophagus. The median time needed to detect metachronous cancer, occurring in organs other than the esophagus, was 58 months(range 18~133 months)after EMR. At a median follow-up of 9 years, death occurred in 31 cases. 15 patients died as a result of other diseases, 16 patients died of other carcinomas, but no one died of esophageal carcinoma. 9 patients died of metachronous cancer occurring in organs other than the esophagus. The overall survival rate at 5 years was 93%, and at 10 years the survival rate was 70%.

 Most of the m1・m2 esophageal cancers were cured by EMR. However, in order to detect both metachronous multiple primary cancers and the cancers occurring in organs other than the esophagus, patients with esophageal cancer should therefore be carefully followed up for 10 years after the diagnosis of esophageal cancer.

Copyright © 2007, Igaku-Shoin Ltd. All rights reserved.


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