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Early Carcinoma of the Esophagus Kinichi nabeya 1 1Second Surgical Deparment, School of Medicine, Chiba University pp.1205-1213
Published Date 1970/9/25
DOI https://doi.org/10.11477/mf.1403111308
  • Abstract
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 Early esophageal cancer is defined as carcinomatous lesion of the esophagus with its infiltration limited within the submucosal layer regardless of the presence or absence of lymph node metastasis. It is further stated that early esophageal carcinoma receiving preoperative irradiation should be named as “R-early carcinoma” as distinguished from nonirradiated early carcinoma. However, since this division still contains many controversial points, the R-early carcinoma in this paper is limited to esophageal cancer in which carcinomatous infiltration can not have reached the musclar coat before irradiation. This distinction has been adopted to rule out those advanced carcinomas in which cancer cells have disappeared at least in or beyond the musclar coat by preoperative irradiation, leaving evidence of cicatrization or atrophy there.

 The progress in various diagnostic methods has enabled us to diagnose carcinoma of the esophagus in its early stage. Thus 28 cases of early esophageal carcinoma have been reported in Japan. They include 19 males and 9 females. The age ranged from 34 to 75 years with the greatest incidence between 50 and 59 years.

 The chief complaints are, in many instances, retrosternal pain, dysbhagia and/or unusual feeling upon swallowing. The complaints are often of short duration of 2~3 months.

 As for the site of the lesion, it was in the cervical portion in 4, the upper thoracic portion in 3, the middle thoracic portion in 14, and the lower thoracic portion in 7, showing higher incidence in the middle and lower thoracic portions. They were all squamous cell carcinomas histologically.

 As for the radiographical configuration, it was tumor type in 15, superficial type in 6, and serrated type in 5, while uncertain in 2 cases.

 Endoscopy was performed in 25 cases, in which the lesion was of superficial type in 21, elevated type in 1, depressed type in 2 and uncertain in 1.

 Biopsy and cytology were carried out in 21 cases, all of which were preoperatively correctly diagnosed as of carcinoma except in one case which was diagnosed as a benign tumor. This illustrates high accuracy of this method of diagnosis.

 The examination with 32P, performed in 3 cases, made it possible to diagnose an extremely small carcinoma. Therefore, the above-mentioned various methods should be combined for accurate diagnosis.

 The lesions were all within 4cm in diameter except one which was a surface-expanding type of more than 6cm in diameter. The grade of depth extension was intramucosal (m) in 3 submucosal (sm) in the other 25 cases.

 The operative technique varied in different institutions, but the direct operative mortality was only one in 28 cases (3%).

 The long-term results are much better than those of advanced carcinomas. However, one patient showed intravascular infiltration even in the early stage, dying of a recurrence. Furthermore, there were 3 early postoperative deaths, indicating difficulty in the postoperative care.


Copyright © 1970, Igaku-Shoin Ltd. All rights reserved.

基本情報

電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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