Early esophageal cancer: the significance of surgery, endoscopy, and chemoradiation
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- Stefan Mönig
- Visceral Surgery Department Geneva University Hospital Geneva Switzerland
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- Mickael Chevallay
- Visceral Surgery Department Geneva University Hospital Geneva Switzerland
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- Nadja Niclauss
- Visceral Surgery Department Geneva University Hospital Geneva Switzerland
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- Thomas Zilli
- Department of Radiation Oncology Geneva University Hospital Geneva Switzerland
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- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital Clinical Center for Esophageal Diseases Shanghai Jiaotong University Shanghai China
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- Ajay Bansal
- Gastroenterology and Hepatology University of Kansas Medical Center Kansas City Kansas
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- Jens Hoeppner
- Department of General and Visceral Surgery, Faculty of Medicine University of Freiburg Medical Center Freiburg Germany
説明
<jats:title>Abstract</jats:title><jats:p>Early carcinomas of the esophagus are histologically classified as adenocarcinoma or squamous cell carcinoma and microscopically subdivided into mucosal and submucosal carcinomas depending on infiltration depth. The prevalence of lymph node metastasis in mucosal carcinoma remains low. However, lymph node metastases arise frequently from tumors with submucosal infiltration, with increasing prevalence in the deeper submucosal sublayers. According to current German guidelines, endoscopic resection is the recommended treatment in mucosal adenocarcinoma without histologic risk factors (lymphatic invasion 1, vascular invasion 1, >grade 2, R1‐margin). In superficial submucosal infiltration without histologic risk factors, endoscopic resection can be considered. In squamous cell carcinoma, endoscopic resection is indicated up to middle layer mucosal carcinoma. Beyond these criteria, surgical resection should be considered. The gold standard is a subtotal transthoracic esophagectomy with two‐field lymphadenectomy. Total esophagectomy is performed in cervical esophageal carcinoma and transhiatal extended gastrectomy in carcinoma of the cardia. Minimally invasive procedures show good oncologic results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection. In early squamous cell cancer, the combination of endoscopic resection and adjuvant chemoradiotherapy is a therapeutic option with promising results.</jats:p>
収録刊行物
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- Annals of the New York Academy of Sciences
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Annals of the New York Academy of Sciences 1434 (1), 115-123, 2018-08-23
Wiley
