SUPERFICIAL ESOPHAGEAL-CARCINOMA

Background. The detection of superficial esophageal carcinomas by surv eillance endoscopy and the downstaging of advanced carcinomas to super ficial carcinomas by induction therapy have increased the number of pa tients with these carcinomas undergoing resection. The natural history of these carcinomas is not well defined. Methods. To evaluate the res ults of surgical resection and identify predictors of improved surviva l, a retrospective review of (1) patients with superficial esophageal carcinoma at presentation (SECP) and (2) patients with advanced carcin omas that were downstaged to no residual carcinoma or superficial esop hageal carcinoma after induction therapy (SECD) was conducted. Results . There were 54 patients with SECP (19 Tis and 35 T1). Survival was si gnificantly better for patients with Tis carcinomas (85.3% at 5 years) and patients with intramucosal T1 carcinomas (79.4%) than for patient s with submucosal T1 carcinomas (16.3%) (p = 0.007 and p = 0.045, resp ectively). Survival at 5 years for the 49 patients without regional ly mph node metastases (N0) was 65.2%, whereas none of the 5 patients wit h regional lymph node metastases (N1) have survived more than 3 years (p = 0.054), and 3 died of recurrent disease. There were 21 patients w ith SECD (13 T0, 2 Tis, and 6 T1). Survival at 4 years was 58.2%. In t his group, survival was not related to depth of tumor invasion (p = 0. 76) or regional lymph node status (p = 0.68). Conclusions. We conclude that (1) patients with Tis and intramucosal T1 SECP have a significan tly better survival than those with submucosal T1 SECP, (2) patients w ith N0 SECP have a significantly better survival than those with N1 SE CP, and (3) survival of patients with SECD is not related to depth of tumor invasion or regional lymph node status.