Feasibility of endoscopic resection in superficial esophageal squamous carcinoma

Background: Endoscopic resection in patients with superficial esophageal squamous carcinoma (SESC) is limited by the presence of lymph node metastasis (LNM), highlighting the importance of determining patients have virtually no risk of LNM. Objective: To investigate the clinicopathological parameters predicting LNM in patients who underwent esophagectomy for SESCs and to identify the best candidate patients for endoscopic resection. Design: Retrospective, single-center study. Setting: Tertiary-care center. Patients: A total of 190 patients who underwent esophagectomy for SESCs between 1991 and 2009. Interventions: Esophagectomy with lymph node dissection. Main Outcome Measurements: LNM Results: Of 190 patients, 39 (20.5%) had LNM. The rates of LNM in patients with m1, m2, m3, sm1, sm2, and sm3 lesions were 0.0% (0/18), 8.7% (4/46), 25.0% (6/24), 15.0% (3/20), 26.0% (7/27), and 37.3% (19/51), respectively. On multivariate analysis, lymphovascular invasion (LVI) (p < .001), superficial tumor size (P = .004), and lower LMM (lamina muscularis mucosae) invasion width (P < .001) were independent predictors of LNM in patients with SESC invading the LMM. Among 63 patients with mucosal or sm1 cancer 3 cm or smaller, only 1 had LNM without LVI showing a lower LMM invasion width greater than 3.0 mm. Limitations: Retrospective analysis. Conclusions: Endoscopic resection should be performed for mucosal cancer of 3 cm or less without positive lymph nodes. Moreover, if pathological examination of the endoscopically resected specimens shows invasion of the sm1 layer and a lower LMM invasion width of 3.0 mm or less, indicating an absence of LVI, the patient can be carefully observed without additional treatment. (Gastrointest Endosc 2011;73:881-9.)