MEASUREMENT OF EXTENT OF SPREAD OF ESOPHAGEAL SQUAMOUS CARCINOMA BY SERIAL SECTIONING

Objectives-(1) To examine the prevalence and extent of intramural meta stasis in squamous cell carcinomas of the oesophagus so as to delineat e the resection margins for these tumours; (2) to devise an appropriat e method for measurement of these lesions which takes into account of the contraction of the specimens after resection. Methods-Oesophagecto my specimens were prospectively collected from 96 patients (87 males, nine females) with primary oesophageal squamous cell carcinoma over a two year period. The sizes of the tumours were measured in situ, after resection and after application of muscle relaxant (to regain their i n situ length). The specimens were then serially sectioned for histolo gical examination. Results-The sizes of the tumours measured after app lication of muscle relaxant roughly corresponded to those measured in situ. Intramural metastasis was observed in 26% of the cases. Sixty fo ur per cent (16 cases) of these were on the oral side, 72% (18 cases) on the gastic side, and 25% (nine cases) on both sides of the tumours. The most distant extent of intramural metastasis from the primary tum our was from 0.5 cm to 9.5 cm (mean = 3.4 cm) on the oral side, and 0. 5 to 9.5 cm (mean 4 cm) on the gastric aspect of the tumour. Intramura l metastasis was seen only in patients in whom the primary cancer had deep muscle infiltration. Multiple neoplastic lesions could be detecte d in 33% of the patients. Both intramural metastasis and multiple neop lastic lesions were associated with extensive lymph node infiltration. However, they had different histological features and extent of infil tration. Conclusions-Intramural metastasis was frequently observed in oesophageal squamous cell carcinoma. This implies that excision with w ide margins should be considered for local control of the disease.